Craniometric and Volumetric Analysis of Posterior Vault Distraction Osteogenesis: 10 Year Update
Zachary D Zapatero1, Christopher L Kalmar, Mychajlo S Kosyk
1Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Posterior vault distraction osteogenesis (PVDO) in younger patients leads to greater intracranial volume increases. This study quantifies cranial vault changes, showing benefits of early intervention for craniosynostosis.
Area of Science:
- Neurosurgery
- Pediatric Plastic Surgery
- Craniofacial Surgery
Background:
- Multisuture craniosynostosis requires surgical correction.
- Posterior vault distraction osteogenesis (PVDO) is a surgical technique to increase cranial volume.
- Understanding volumetric changes is crucial for optimizing treatment outcomes.
Purpose of the Study:
- Quantify volumetric changes in anterior, middle, and posterior cranial vaults after PVDO.
- Characterize changes in cranial length, width, and height.
- Correlate changes with demographics to identify factors influencing volume gain, particularly in younger patients.
Main Methods:
- Retrospective review of multisuture craniosynostosis patients undergoing PVDO.
- Analysis of pre- and post-operative CT scans using Materialise Mimics software.
- Comparison between "old" and "young" patient cohorts.
Main Results:
- Cranial length increase was less than expected distraction distances.
- Anterior cranial height was significantly shorter post-PVDO.
- Younger patients exhibited a significantly greater increase in total intracranial volume (37.1% vs. 12.0%).
Conclusions:
- This is the first study to quantify volumetric changes in all three cranial vault sections post-PVDO.
- Performing PVDO at a younger age is beneficial for controlling turricephaly and achieving greater volumetric increases.
- Early intervention in pediatric craniosynostosis management is supported by these findings.
Purpose:
The purpose of this study is to quantitatively establish the volumetric changes observed with posterior vault distraction osteogenesis in the anterior, middle, and posterior thirds of the cranial vault; characterize change in cranial length, width, and height, correlating these changes to demographic variables that may help identify why younger kids gain more volume; and describe the short-term position of the transport segment.
Methods:
Multisuture craniosynostosis patients who underwent posterior vault distraction osteogenesis were retrospectively reviewed. Pediatric, dose-reduced, thin cut helically acquired head computed tomography scans were analyzed on Materialise Mimics v22 (Materialise, Ghent, Belgium). Pre and post-PVDO and "old" and "young" cohort were compared.
Results:
Twenty-one patients met inclusion criteria. The change in cranial length was significantly less at a median of 14.9 mm [Interquartile range (IQR) 11.8, 31.6] compared to the X-ray measured AP distraction distance (30 mm [IQR 24, 33]; P < 0.001) and significantly less than the theoretically calculated distance (23 mm [IQR 19, 31]; P = 0.012). Median anterior cranial height was shorter post PVDO (82.9 mm, [IQR 64.8, 92.6] versus 78.7 mm [IQR 57.0, 88.7]; P = 0.030). The younger cohort saw a greater increase in total intracranial volume (median 335.1 mL [IQR 163.2, 452.3, median 37.1%] versus 144.6 mL [IQR 119.0, 184.8, median 12.0%]; P = 0.011).
Conclusions:
This is the first study to quantify volumetric changes to the anterior, middle, and posterior cranial vaults and demonstrates benefits of preforming PVDO at a younger age to help control turricephaly and produce greater percentage volumetric increases.
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