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Experiences in Performing Posterior Calvarial Distraction.

Kevin McMillan1, Mark Lloyd, Martin Evans

  • 1Birmingham Children's Hospital, Birmingham, UK.

The Journal of Craniofacial Surgery
|May 5, 2017
PubMed
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Posterior calvarial distraction (PCD) effectively increases cranial volume and decreases intracranial pressure in craniosynostosis patients. This study reviews 50 cases, highlighting favorable outcomes and recommending PCD as a primary treatment.

Area of Science:

  • Neurosurgery
  • Pediatric Surgery
  • Craniofacial Surgery

Background:

  • Posterior calvarial distraction (PCD) is a recognized technique for managing craniosynostosis.
  • PCD offers benefits such as increased cranial volume, reduced intracranial pressure, and improved cerebrospinal fluid (CSF) circulation.

Purpose of the Study:

  • To retrospectively review the outcomes of the first 50 patients who underwent PCD.
  • To analyze complication rates and identify favorable outcomes associated with PCD.

Main Methods:

  • Retrospective review of 50 patients undergoing PCD between October 2006 and September 2015.
  • Data collected from an electronic craniofacial database and patient records, including demographics, diagnoses, surgical approach, and outcomes.
  • Analysis of complication rates: bleeding, distraction problems, CSF leaks, and infection.

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Main Results:

  • 31 boys and 19 girls underwent PCD, with a median age of 17.7 months; 34 were syndromic.
  • Median inpatient stay was 9.4 days, with an average distraction of 24 mm.
  • Overall complication rate was 50%, with severe complications in 3 patients. Favorable outcomes included resolution of Chiari, syrinx, and elevated intracranial pressure.

Conclusions:

  • PCD is recommended as a primary treatment for increasing calvarial volume in craniosynostosis.
  • The study discusses experiences and technical innovations in PCD over a decade.
  • PCD can lead to resolution of associated conditions like Chiari malformation and syringomyelia.