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Results and limits of posterior cranial vault expansion by osteotomy and internal distractors

Federico Di Rocco1, Kenichi Usami1, Tatiana Protzenko1

  • 1Craniofacial Unit, Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Paris, France.

Surgical Neurology International
|December 4, 2018
PubMed

Insights

Posterior cranial vault distraction effectively expands the skull in children with craniosynostosis. This surgical technique improves symptoms of increased intracranial pressure (ICP) and cerebellar tonsil herniation (TH).

Area of Science:

  • Neurosurgery
  • Pediatric Surgery
  • Craniofacial Surgery

Background:

  • Posterior cranial vault expansion is a common treatment for complex craniosynostosis.
  • Various techniques exist for posterior vault remodeling.
  • Posterior vault distraction osteogenesis is an emerging surgical approach.

Purpose of the Study:

  • To analyze the outcomes of posterior vault distraction osteogenesis.
  • To evaluate its efficacy in treating craniosynostosis-related complications.

Main Methods:

  • A retrospective study of 21 children (mean age 8.6 months) undergoing posterior cranial vault distraction between 2011 and 2014.
  • Patients included those with craniofacial syndromes, prior surgeries, elevated intracranial pressure (ICP), and symptomatic cerebellar tonsil herniation (TH).
  • Distraction osteogenesis involved placing 2 to 4 distractors, with volumetric analysis via CT scans.

Main Results:

  • A mean posterior cranial vault volume increase of 13.9% was observed 117 days post-distraction.
  • All patients experienced improvement in symptoms related to elevated ICP or TH.
  • Radiological improvement of cerebellar tonsil herniation (TH) was noted in 54% of cases at the last follow-up.

Conclusions:

  • Posterior cranial vault distraction is an effective method for enlarging the posterior skull.
  • The technique successfully treats elevated intracranial pressure (ICP) in pediatric patients.
  • It also shows efficacy in managing symptoms associated with cerebellar tonsil herniation (TH).
Abstract

Keywords:
Chiaricraniosynostosisoutcomeposterior cranial vaultskull remodelingsyndromic craniosynostosis

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