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Three-Dimensional Volumetric Changes in Posterior Vault Distraction With Distraction Osteogenesis
Meena Thatikunta1, Luke Pearson1, Candice Nguyen1
1Department of Neurological Surgery, University of Louisville School of Medicine.
The Journal of Craniofacial Surgery
|April 14, 2020
Summary
Distraction osteogenesis effectively expands the posterior vault in lambdoid craniosynostosis, especially in unilateral cases. Optimal volumetric gains are achieved with inferior suture distractor placement and osteotomy to the asterion.
Area of Science:
- Craniofacial surgery
- Pediatric neurosurgery
- 3D imaging analysis
Background:
- Distraction osteogenesis (DO) offers potential for significant posterior vault (PV) expansion.
- Limited data exists on surgical planning and 3D volumetric outcomes for PV distraction.
Purpose of the Study:
- To investigate volumetric changes in the posterior vault following distraction osteogenesis for lambdoid craniosynostosis.
- To analyze factors influencing volumetric gains in PV distraction surgery.
Main Methods:
- Retrospective review of 11 lambdoid craniosynostosis patients treated with PVDO (2007-2019).
- Pre- and postoperative 3D volumetric analysis using CT scans and 3D Slicer software.
- Comparison of volumetric changes based on synostosis type, osteotomy location, and distractor placement.
Main Results:
- Posterior fossa volume (PFV) increased by 38.7% and foramen magnum area by 26.9%.
- Unilateral lambdoid synostosis showed significantly greater PFV increase (63.5%) than bilateral (8.9%).
- Osteotomy to the asterion and inferior distractor placement yielded maximal PFV gains.
Conclusions:
- Unilateral lambdoid synostosis achieves the highest volumetric increases with PVDO.
- Osteotomy beyond the asterion is not required for maximal PV volumetric gain.
- Inferior third distractor placement maximizes posterior vault volumetric gains.
