Use of cross-bone strut stabilization for barrel stave osteotomies in calvarial reconstruction

Techniques using barrel stave osteotomies have become commonplace in cranial vault reconstruction. Unfortunately, the ability of the barrel staves to maintain their expanded position is dependent on the dynamics of the surrounding soft tissue envelope and the support of the underlying brain because they are not fixed transversely. This article presents the use of cross-bone strut stabilization as a modification of the barrel stave technique to minimize collapse and help maintain the desired shape of the cranial vault.

Bone grafts harvested from the inner table of the cranial bone flaps were fashioned into rectangular struts. The struts were fit between the expanded ends of barrel staves after the desired shape and contour was achieved and fixed with resorbable plates and/or resorbable suture.

Eighty-six of 139 consecutive patients treated for sagittal, metopic, or lambdoid craniosynostosis had cross strut stabilization in conjunction with barrel stave osteotomies for a mean age of 9.8 months and a mean follow-up of 4.9 years. This technique provided excellent and predictable aesthetic results that resisted relapse under the constraining forces of the overlying scalp. The stabilized barrel stave cohort had 2 minor complications (2.3%) and 2 major complications (2.3%), none of which was directly related to this technical nuance.

In properly selected patients, cross-bone strut stabilization can enhance the stability of barrel stave osteotomies. The described technique leads to a long-lasting restoration of an aesthetically pleasing cranial shape and a sturdy framework into which the brain can expand and grow unimpeded.