Anesth Pain Med.  2021 Apr;16(2):151-157. 10.17085/apm.20069.

Preoperative cephalhematoma size measured with computed tomography predicts intraoperative bleeding in pediatric patients undergoing cranioplasty

  • 1Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 2Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
  • 3Department of Pediatric Neurosurgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 4Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea


Cranioplasty for the treatment of cephalhematomas in small infants with limited blood volume is challenging because of massive bleeding. This study aimed to elucidate the correlation between cephalhematoma size and intraoperative blood loss and identify criteria that can predict large intraoperative blood loss.
We reviewed the medical records of 120 pediatric patients aged less than 24 months who underwent cranioplasty for treatment of a cephalhematoma. The cephalhematoma sizes in preoperative brain computed tomography (CT) were measured using ImageJ.
Pearson correlation showed that the cephalhematoma size in the pre-operative brain CT was weakly correlated with intraoperative blood loss (Pearson coefficient = 0.192, P = 0.037). In a multivariable logistic regression analysis, a cephalhematoma size greater than 113.5 cm3 was found to be a risk factor for large blood loss. The area under the curve in the receiver operating characteristic plot of the multivariable model was 0.714 (0.619–0.809).
A cephalhematoma size cutoff value of 113.5 cm3, as measured in the preoperative CT imaging, can predict intraoperative blood loss exceeding 30% of the total body blood volume. The establishment of a transfusion strategy prior to surgery based on cephalhematoma size could be useful in pediatric cranioplasty.


Cephalhematoma; Cranioplasty; Intraoperative bleeding; Prediction


  • Fig. 1. Brain computed tomography images opened in ImageJ.

  • Fig. 2. Scatter plot showing the correlation between the cephalhematoma size and intraoperative blood loss (A) and that between the cephalhematoma size and the amount of transfusion (B).

  • Fig. 3. Receiver operating characteristic plot of the categorized cephalhematoma size (A), and of the multivariable model (B). Area under the curve: 0.635 (0.536–0.734) and 0.714 (0.619–0.809), respectively.


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