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Spring-assisted posterior vault expansion in multisuture craniosynostosis
T de Jong1, M L C van Veelen, I M J Mathijssen
1Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands. t.dejong@erasmusmc.nl
Insights
Spring-assisted posterior vault expansion offers greater skull growth than conventional methods for Apert and Crouzon syndromes. This technique is preferred due to its efficacy in treating raised intracranial pressure.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Plastic Surgery
Background:
- Apert and Crouzon syndromes require early vault expansion to prevent intracranial pressure.
- Conventional posterior vault expansion is a common initial surgical approach.
- Spring-assisted posterior vault expansion presents an alternative technique.
Purpose of the Study:
- To evaluate the efficacy of spring-assisted posterior vault expansion.
- To compare spring-assisted with conventional posterior vault expansion.
Main Methods:
- Retrospective study of 31 patients (2006-2011) undergoing posterior vault expansion.
- Comparison of spring-assisted versus conventional techniques.
- Analysis of blood loss, surgery duration, hospital stay, skull growth, and complications.
Main Results:
- Spring-assisted group showed significantly greater increases in skull circumference and anterior-posterior length.
- No significant difference in blood loss between groups.
- Complications varied, with skin perforation and dural tears noted in the spring group.
Conclusions:
- Spring-assisted posterior vault expansion demonstrates advantages over the conventional method.
- This technique is favored in the center for craniofacial reconstruction.
- Effective for managing raised intracranial pressure in pediatric syndromes.
Purpose:
Patients with Apert and Crouzon syndromes and craniofrontonasal dysplasia need a vault expansion within the first year of life to treat or prevent the development of raised intracranial pressure. Many craniofacial units perform a conventional posterior vault expansion as initial surgery; an alternative to this technique is the spring-assisted posterior vault expansion. The purpose of this study was to demonstrate the efficacy of spring-assisted posterior vault expansion and to compare this technique with the conventional method.
Methods:
A retrospective study was conducted among all consecutive patients who received a posterior vault expansion between 2006 and 2011. Patients treated with springs were compared with patients treated with the conventional technique for blood loss, duration of surgery, postoperative hospital admittance, increase in skull circumference and anterior-posterior length, and complications.
Results:
Of the 31 included patients, 15 were treated with springs, and 16, with the conventional technique. Patients treated with springs had a significantly larger increase in skull circumference and anterior-posterior length, and not significant changes in blood loss compared with the conventional group. Complications in the conventional group were the following: minor dural tear in three patients, problematic wound healing in one patient, and insufficient expansion in one patient. Spring-related complications included skin perforation in two patients, a minor dural tear in two patients, and leakage of cerebrospinal fluid after an unnoticed dural tear during spring placement in one patient.
Conclusion:
Spring-assisted posterior vault expansion has some advantages over the conventional technique and is, therefore, the preferred technique in our center.
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