A comparative study of anterior cranial vault distraction versus remodeling

The use of distraction for treating craniosynostosis offers the potential to achieve greater calvarial enlargements than with single-staged procedures. However, distraction does require 2 operative procedures and a prolonged treatment course. We sought to compare our experience with these 2 techniques to determine relative effectiveness and to refine indications.

A retrospective case-controlled review of age-matched children with syndromic synostosis undergoing anterior cranial vault enlargement utilizing either distraction or conventional remodeling was performed. Complication and reoperative rates were tracked, and results were assessed using serial anthropometric measurements.

Over a 19-month period, 10 children with Apert syndrome underwent calvarial enlargement, 5 by distraction (mean age 28 mo) and 5 by standard remodeling (mean age 31 mo). The average distraction distance was 26 mm. Distraction patients initially underwent 2.25 operations versus 1 operation for the remodeling group. Some aesthetically undesired skull widening was noted in 2/5 patients undergoing distraction (the youngest patients). Anthropometry (length, height, circumference, volume) revealed no significant differences between the 2 treatment groups. With a mean follow-up of 9.7 years, 2/5 distraction patients underwent secondary procedures versus 1/5 of the remodeling group.

These analyses revealed less skull enlargement was actually achieved utilizing distraction than anticipated. We were unable to demonstrate any significant advantages of this distraction technique over our remodeling procedures with respect to either anthropometric skull measurements or the avoidance of future enlargement procedures. Given the burdens of distraction, further comparative clinical trials are needed to better refine indications for this emerging technique.