Cranial distraction osteogenesis for syndromic craniosynostosis: long-term follow-up and effect on postoperative
Kazuaki Yamaguchi1, Keisuke Imai1, Takuya Fujimoto1
1Department of Plastic and Reconstructive Surgery, Osaka General City Hospital, 22-13-2 Miyakojimahondori, Miyakojima-ku, Osaka City, Osaka, Japan.
Insights
Cranial distraction osteogenesis (CDO) effectively expands skulls in infants with craniosynostosis, showing initial growth suppression followed by normalization. This technique is suitable for younger infants needing significant cranial expansion.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Medical Engineering
Background:
- Cranial distraction osteogenesis (CDO) offers benefits for craniosynostosis but lacks detailed reports on operative procedures and postoperative cranial growth.
- Objective effectiveness of CDO in younger infants with craniosynostosis requires further investigation.
Purpose of the Study:
- To demonstrate the objective effectiveness of cranial distraction osteogenesis (CDO) in younger infants with craniosynostosis.
- To analyze postoperative cranial growth patterns and compare them to normal populations.
Main Methods:
- Computed tomography (CT) data from 10 infants undergoing primary CDO for craniosynostosis were analyzed using Mimics software.
- Cranial volumes were calculated and compared to the Abbott curve for a normal population.
- Cranial growth gap was defined to assess perioperative effects on cranial growth.
Main Results:
- All 10 infants showed postoperative cranial growth, with final volumes within ±2 standard deviations of the normal population.
- A temporary decline in cranial growth gap was observed postoperatively, indicating initial growth suppression.
- A formula was derived to predict CDO target volume based on the declining cranial growth gap curve.
Conclusions:
- Cranial distraction osteogenesis (CDO) is a suitable and effective procedure for younger infants requiring aggressive cranial expansion.
- CDO facilitates significant cranial vault remodeling in infants with syndromic craniosynostosis.
Background:
Although cranial distraction osteogenesis (CDO) is beneficial, few studies have reported on detailed operative procedures and postoperative cranial growth. Herein, we demonstrated the objective effectiveness of CDO in younger infants.
Methods:
The study included infants who underwent primary cranial distraction for craniosynostosis. Infants who had hydrocephalus were excluded and those who underwent additional osteotomy surgeries were analysed before the subsequent procedures. The infants' computed tomography data were analysed using Mimics(®) software (Materialise, Leuven, Belgium) to calculate the cranial volumes and compare them with the Abbott curve for a normal population. We defined cranial growth gap as the difference between the subject data and normal infant data to demonstrate the perioperative effects on cranial growth.
Results:
CDO was performed in 10 infants. The mean infant age at the time of surgery was 6.4 months (range, 24--61 months) and the mean duration of postoperative follow-up was 38.9 months (range, 24--61 months). Five infants with Crouzon syndrome and five with Apert's syndrome were included. All infants showed postoperative cranial growth, but cranial growth gap showed postoperative declines for a certain period, indicating cranial growth suppression immediately following expansion. At the last follow-up, all cases were within ±2 standard deviation (SD) compared with the normal population. We derived a formula to predict the CDO target volume using the declining cranial growth gap curve.
Conclusions:
CDO was applicable and suitable for younger infants requiring aggressive cranial expansion.
