A Posterior Rotational Flap Technique Using Distraction Osteogenesis for Unilateral Lambdoid Craniosynostosis

Area of Science:

• Neurosurgery
• Craniofacial Surgery
• Pediatric Surgery

Background:

• Unilateral lambdoid craniosynostosis presents craniofacial asymmetry challenging traditional treatments.
• Limitations in soft-tissue expansion and relapse hinder outcomes with current methods like posterior cranial vault remodeling and distraction osteogenesis alone.

Purpose of the Study:

• To evaluate the efficacy of a posterior rotational cranial-flap technique combined with internal distraction osteogenesis for unilateral lambdoid craniosynostosis.
• To assess the impact on intracranial volume and relapse rates in affected patients.

Main Methods:

• A posterior rotational flap osteotomy was performed with internal distraction osteogenesis, prioritizing dural preservation.
• Preoperative virtual surgical planning guided the reconstruction.
• Primary outcomes included age-adjusted volume change and volume change per millimeter of distraction.

Main Results:

• Five patients underwent the procedure, showing a mean age-adjusted intracranial volume increase of 14.1%.
• The mean volume change was 0.43% per millimeter of distraction.
• One patient experienced a manageable distractor site infection; all achieved a Whitaker score of 1 at one year.

Conclusions:

• The posterior rotational cranial-flap technique with internal distraction osteogenesis effectively maximizes bone flap viability and minimizes relapse in unilateral lambdoid craniosynostosis.
• This approach offers a promising alternative for managing complex craniofacial deformities.