How Much Skull Reduction Can Be Safely Done?

Q: Dr. Eppley, I asked you about my skull shape problem before but I don’t think I’ve describe it accurately.The problem with my “big head” has been troubling for years and I hope to resolve it once and for all.

Here is my problem:

My head looks normal when viewed from the front or back. But when viewed sideways, it looks big. Specifically, the distance between the forehead to the back (the occipital region) is too large.

If one would to look at the top of my head from a bird’s eye view, the back region is sort of a “trapezoidal” shape, in that the middle portion protrudes too much out. I wonder if it’s possible to “push back” on the middle portion and fill up the side, so that the head will be a more flat or rounded shape rather than trapezoidal.

I think the only way this can be done is via a partial removel of the skull, and putting it back like a jigsaw, or maybe even replacing that portion with an artificial skull. I wonder if this is within your specialty. I heard the risk of death or disablement from this might be as high as 50% so I might not do it if that’s the case.

My goal is to reduce the said distance between the forehead to the back by 20mm. On your website, most of the skull reduction procedure I’ve read about deals with mechanically removing a portion of the skull and making it thinner. I’m not sure if that would be enough in my case. I’ve read that the human skull thicknes is only about 10cm thick at most.

A: Realistically what you are asking can not be done. The outer portion of the skull can be shaved down by removing the outer cortex. When done in the forehead and occiput, the anteroposterior (front to back) distance can be reduced probably 10 to 12mms at best. You can not remove skull pieces and put them back together any way you want because of the space occupied by the brain. This space can not be reduced or intruded upon, only the outer portions of the skull can be reduced which protects and maintains the intracranial space for the brain.

Dr. Barry Eppley

Indianapolis, Indiana