Experience with craniosynostosis treatment using posterior cranial vault distraction osteogenesis
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Leena P Ylikontiola1, George K Sándor, Niina Salokorpi
1Department of Oral and Maxillofacial Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland.
Insights
Posterior cranial vault distraction osteogenesis (PCV DO) effectively reduced intracranial pressure (ICP) in children with craniosynostosis. This surgical technique offers a promising treatment for improving cranial growth and managing ICP.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Orthopedic Surgery
Background:
- Craniosynostosis significantly restricts cranial vault volume and growth, potentially leading to increased intracranial pressure (ICP).
- Posterior cranial vault (PCV) distraction osteogenesis (DO) is a surgical intervention for craniosynostosis.
- This study evaluates the outcomes of PCV DO.
Purpose of the Study:
- To describe the outcomes of posterior cranial vault (PCV) distraction osteogenesis (DO).
- To assess the efficacy of PCV DO in managing increased intracranial pressure (ICP) in pediatric patients.
Main Methods:
- A cohort of 16 pediatric patients (9 males, 7 females) underwent PCV DO.
- Miniaturized, single-vector distraction devices with quick-disconnect rods were utilized in all cases.
- Patients included those with prior cranioplasty and those presenting with elevated ICP.
Main Results:
- Seven patients had a history of prior cranioplasty.
- All reoperations were indicated for elevated ICP, affecting syndromic and scaphocephaly patients.
- A substantial postoperative decrease in ICP was observed in all patients.
Conclusions:
- PCV DO yielded encouraging outcomes in managing craniosynostosis and associated ICP.
- Optimal placement of distractor stems minimizes the risk of future trauma.
- The use of miniaturized distractors allows for precise control over distraction rate and magnitude.
Background:
Craniosynostosis compromises the cranial vault volume, severely impede growth, and may lead to increased intracranial pressure (ICP). Posterior cranial vault (PCV) distraction osteogenesis (DO) offers an excellent treatment opportunity for this condition. This article intends to describe the outcomes of PCV DO.
Materials And Methods:
Nine males and seven female children indicated for PCV DO were included in the study. The single vector distraction devices with quick-disconnect distraction rods, a type of miniaturized hardware, was used in all cases.
Result:
Seven of the 16 patients had a history of one or more prior cranioplasty. All reoperations in this series were performed for the indication of raised ICP including five of the scaphocephaly patients and the syndromic patients. Clinical signs of raised ICP were present in all patients with either measured raised intracranial pressure or those with clinical signs of raised ICP preoperatively. There was substantial decrease in the ICP postoperatively.
Discussion:
The outcomes of this study were encouraging. Placing the distractor stems as flat as possible against the outer layer of the cranial bone seems to be a very important maneuver. This keeps the distractor stem less proud and less likely to sustain future trauma. Removal of the distractor stems keeps the devices further away from the risk of later traumatic dislodgement. Moreover, miniaturized distractors allow precise control of the rate and the amount of distraction.
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