his head looks big in that photo. One of the big things used in the photo analysis has been the size of his head..for example, the one where lolo and ann are sitting on the couch.
It may be that he had some kind of disorder and thus the need for head surgery/possible shunt. One person said it looked like he has a shunt. I did find a photo that looked like it to me except I dont know what a shunt looks like..but there was a definite bulge behind his ear area.