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A Perioperative Risk Comparison of Posterior Vault Distraction Osteogenesis in an Older Pediatric Population
Jing Li1, Patrick A Gerety, Wen Xu
1Department of Surgery, The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA.
Insights
Posterior cranial vault distraction osteogenesis (PVDO) is effective for older children with syndromic craniosynostosis. Outcomes are similar to infants, showing PVDO is a viable option for expanded cranial vault treatment.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Plastic Surgery
Background:
- Posterior cranial vault distraction osteogenesis (PVDO) is increasingly used for infants with syndromic craniosynostosis.
- Limited data exists comparing PVDO outcomes in older children versus infants.
Purpose of the Study:
- To compare perioperative outcomes of PVDO in older patients (≥5 years) versus infants with syndromic craniosynostosis.
Main Methods:
- A prospective craniofacial database was queried for patients undergoing PVDO.
- Twenty older patients were compared to diagnosis-matched infants.
- Demographic, perioperative, and distraction data were analyzed using t-tests and Fisher exact tests.
Main Results:
- Older patients (mean age 9.2 years) experienced less weight-based blood loss and transfusion compared to infants (mean age 0.7 years).
- Other perioperative variables, including surgical duration, hospital stay, and follow-up, were similar between groups.
- All patients completed PVDO successfully, with older patients showing resolution of papilledema/headaches. Wound infections occurred in one patient from each group.
Conclusions:
- PVDO is a safe and effective procedure for cranial vault expansion in older children with syndromic craniosynostosis.
- Perioperative outcomes are comparable to those in infants.
- PVDO presents a reasonable alternative for older syndromic patients with specific clinical indications.
Abstract:
There is a growing literature on the advantages of posterior cranial vault distraction osteogenesis (PVDO) in infants, particularly those with syndromic and multisuture craniosynostosis. This study aims to compare perioperative outcomes of PVDO in older patients to those of infants. A prospective craniofacial database was queried for patients aged 5 and older undergoing PVDO; controls were diagnosis-matched infants. Demographic, perioperative, and distraction data was compared using a 2-sample t test and Fisher exact test.Twenty patients met inclusion criteria, and all had syndromic craniosynostosis. Mean age was 9.2 years for the older group, and 0.7 years for the younger. Older children had less weight-based blood loss (mean 58.6 ± 38.8 versus 14.6 ± 7.0 cc/kg, control versus older, P = 0.0092) and weight-based transfusion (mean 70.1 ± 37.2 versus 21.2 ± 9.9 cc/kg, control versus older, P = 0.0023); other perioperative variables were similar including duration of surgery, length of stay, distance distracted, time in consolidation, and length of follow-up. All patients in both groups successfully completed PVDO, and all older patients had resolution of papilledema and/or headaches. One from each group developed a wound infection that was treated with oral antibiotics.Posterior cranial vault distraction osteogenesis is a safe and efficacious for cranial vault expansion in syndromic craniosynostosis, with similar perioperative outcomes in older children as compared to infants. Posterior cranial vault distraction osteogenesis may be a reasonable alternative in older syndromic patients with acceptable frontal morphology and concerns for increased intracranial pressure.
