Calcified cephalohematoma is an uncommon complication of cephalohematoma. It occurs when a cephalohematoma is not absorbed within the first weeks of its presentation and begins to ossify over the surface. The calcification may continue to enlarge.
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Epidemiology
Calcification occurs in <5% of cephalohematomas 4.
Pathology
Osteogenesis occurs under the lifted pericranium.
Classification
Calcified cephalohematomas can be classified into two types, which have implications for surgical management 4:
- type 1: the inner lamella located below the cephalohematoma is smooth and non-depressed relative to the surrounding normal cranial vault
- type 2: the inner lamella located below the cephalohematoma is depressed relative to the surrounding normal cranial vault
Radiographic features
Plain radiograph
The double skull sign is present.
CT
CT is the investigation of choice to correctly diagnose calcified cephalohematomas, determine its type, display the extent of calcifications and evaluate the underlying brain parenchyma.
MRI
MRI can be used to assess the state of underlying brain parenchyma especially in cases associated with seizures.
Treatment and prognosis
The management of calcified cephalohematoma depends particularly on the size and type of lesions. Conservative treatment may be considered in small lesions. Surgical intervention is considered when cosmetic deformities are caused by larger lesions; surgical technique varies between the two types. Spontaneous complete resolution has been reported in the literature 3.
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