Rotating distraction osteogenesis in a child with secondary craniosyntostosis

Distraction osteogenesis has been acknowledged as a most effective surgical method to maximize intracranial space in patients with craniosynostosis by progressive displacement of the skull flap. However, it is difficult to control the growth direction of the skull flap even with application of four distraction bars. The authors of this study performed a cranioplasty procedure in a four-year-old girl with brachicephalic microcephaly, who showed a high lumbar puncture pressure of 21 cm H2O. After bilateral frontal craniectomy, the frontal bone and the midline of the superior orbital bone were fixed with a single wire, thus converting the linear displacement of distraction to a rotation flap and raising the skull flap superiorly. This rotational distraction osteogenesis resulted in a longer distance of distraction and upward rotation of the frontal skull flap with only two distraction bars. The authors suggest that rotating distraction osteogenesis has several merits: lesser depression of the bone flap, longer distance of distraction, and it is simpler and more economic than linear distraction. We also advocate that more aggressive surgical procedures should be considered for even older children with high intracranial pressure.