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Extended experience in parieto-occipital expansion surgery by meander technique-clinical and radiological evaluation
Valentina Pennacchietti1, Matthias Schulz1, Anna Tietze2
1Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
Insights
The posterior meander technique significantly increased intracranial volume and improved asymmetry in children with brachycephaly and plagiocephaly. This method offers advantages over other techniques, though further comparative studies are needed.
Area of Science:
- Neurosurgery
- Pediatric Plastic Surgery
- Craniofacial Surgery
Background:
- Brachycephaly and plagiocephaly can be isolated or syndromic.
- Severe cases may require cranioplasty or osteogenetic distraction.
- The posterior meander technique is an alternative surgical approach.
Purpose of the Study:
- To retrospectively review the perioperative course of children treated with the posterior meander expansion technique.
- To analyze postoperative changes in intracranial volume and tonsillar descent.
Main Methods:
- Retrospective review of 42 children treated with posterior cranial vault remodeling using the posterior meander technique.
- Analysis of pre- and postoperative MRIs for intracranial volume, cephalic index, asymmetry index, and tonsillar position.
Main Results:
- Significant postoperative increase in intracranial volume (1188.9 to 1324.8 cm³).
- Significant improvement in the asymmetry index (0.86 to 0.91).
- No significant changes in tonsillar herniation, with a nonsignificant amelioration in older children.
Conclusions:
- The posterior meander technique offers advantages like early mobilization and fewer bony defects.
- The technique leads to significant improvements in intracranial volume and cranial symmetry.
- Further comparative studies are necessary to evaluate different surgical techniques.
Introduction:
Brachycephaly and anterior and posterior plagiocephaly appear as an isolated entity or manifest in syndromic conditions. In severe cases, possible treatment options currently comprise either cranioplasty or osteogenetic distraction. The aim of this paper is to retrospectively review the perioperative course of a series of children treated by posterior meander expansion technique at our institution with focus on the course of postoperative intracranial volume and eventual tonsillar descent evolution.
Methods:
Forty-two children received a posterior cranial vault remodeling by means of a posterior meander technique during a 7-year period. Hospital records were reviewed, and pre- and postoperative MRIs were analyzed for intracranial volume, cephalic and asymmetry index, and tonsillar position over time.
Results:
Median age at surgery was 11.5 months (range 17 days-10 years). Nineteen children had a symmetrical cranial deformity, twenty-three an asymmetrical synostosis. Half of the cohort showed a syndromic condition. Transfusions were administered in the majority (92.2%) of the cases. A significant postoperative increase of intracranial volume was present from 1188.9 ± 370.4 cm3 to 1324.8 ± 352.9 cm3 (p < 0.001). The asymmetry index showed a significant improvement postoperatively: 0.86 ± 0.06 versus 0.91 ± 0.05 (p < 0.001), while the cephalic index showed a non-statistical change (0.91 ± 0.11 versus 0.88 ± 0.08). Tonsillar herniation, bilateral or homolateral, showed no significant changes at early control, while a nonsignificant amelioration of tonsillar descent was seen among children older than 12 months at late imaging follow-up.
Conclusion:
Among the osteoplastic techniques, the posterior meander technique offers several advantages, such as early mobilization of the child, less bony defects, absence of implants, and a small complication rate. However, further comparative studies among different surgical techniques are needed.
