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Complications in Posterior Cranial Vault Distraction.
Matthew R Greives1, Benjamin W Ware, Ashley G Tian
1From the *Department of Plastic Surgery, †Department of Neurosurgery, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh. Pittsburgh, PA; and ‡Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA.
Posterior cranial vault distraction is a safe and effective treatment for elevated intracranial pressure in syndromic craniosynostosis. Complications like CSF leaks and infections can occur but are manageable, with no reported deaths or long-term issues.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Posterior cranial vault distraction is increasingly used for elevated intracranial pressure in syndromic craniosynostosis.
- This method is faster and less complex than other cranial vault remodeling procedures.
- However, it carries unique complications that require careful consideration.
Purpose of the Study:
- To systematically review and analyze complication rates and types associated with posterior cranial vault distraction.
- To identify common complications and their management strategies.
- To evaluate the overall safety and efficacy of this procedure.
Main Methods:
- A comprehensive literature search was conducted for case series and case-control studies on posterior cranial vault distraction.
- Complication data were tabulated and categorized by management approach.
- Corresponding authors were contacted for clarification on unclear outcomes and treatment plans.
Main Results:
- Eleven reports involving 1 to 22 patients were analyzed, with an average age at surgery of 16.2 months.
- Overall complication rates averaged 30%, ranging from 12.5% to 100% across studies.
- The most frequent complications included cerebrospinal fluid leaks, dural injury, infections, device exposure, and device failure. No deaths or long-term morbidities were reported.
Conclusions:
- Posterior cranial vault distraction is a safe and effective treatment for elevated intracranial pressure in syndromic craniosynostosis.
- Common complications involve device interaction with the dura, extrusion, and infection.
- Meticulous device placement and careful dural management are crucial for successful outcomes and complication avoidance.
