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Posterior Calvarial Distraction in older paediatric population: single centre paediatric neurosurgery craniofacial
Fardad T Afshari1, Pasquale Gallo2, Guirish A Solanki2
1Department of Craniofacial Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK. afsharifardad@googlemail.com.
Insights
Posterior calvarial distraction (PCD) is safe and effective in older children (age 6+) for increasing cranial vault volume and reducing intracranial pressure. This study shows comparable outcomes to younger patients, with fewer transfusions needed.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Skeletal Distraction Osteogenesis
Background:
- Posterior calvarial distraction (PCD) is established for complex craniosynostosis in young children.
- Optimal timing and methods for PCD remain debated.
- Limited data exists on PCD efficacy in older children.
Purpose of the Study:
- To evaluate the safety and effectiveness of PCD in children aged 6 and above.
- To outline the applications, benefits, and challenges of PCD in an older pediatric population.
- To compare outcomes of PCD in older versus younger children.
Main Methods:
- Retrospective analysis of 20 patients aged 6+ who underwent PCD (2006-2021).
- Data collected on demographics, clinical outcomes, and imaging.
- Multidisciplinary craniofacial team review and surgical management.
Main Results:
- PCD was performed in 20 patients (mean age 8.8 years) for pansynostosis and raised intracranial pressure.
- Mean distraction achieved was 22.5 mm, with significant symptomatic improvement.
- Complications occurred in 5 patients; older cohort had lower transfusion rates than younger controls.
Conclusions:
- Posterior calvarial distraction is a safe and effective procedure for vault expansion and managing intracranial pressure in selected older children.
- A multidisciplinary team approach is vital for optimal case selection and management.
- PCD offers comparable benefits to younger patients, with potential advantages like reduced transfusion needs.
Purpose:
Posterior calvarial distraction (PCD) is a safe and effective technique used to increase cranial vault volume and therefore reduce intracranial pressure in children with complex craniosynostosis. Optimal timing and method used for PCD is controversial. This procedure is usually performed in children younger than 2 years. Literature regarding calvarial distraction in older children is sparse and limited. We report our single-centre experience with PCD in children aged 6 and above to outline the applications, benefits and challenges of employing this technique in an older paediatric population.
Methods:
A retrospective analysis of a database on craniofacial cases from 2006 to 2021 was performed. Patients undergoing PCD were identified and children aged 6 and above at the time of operation were included. Data on demographics and clinical outcomes were obtained from electronic records and relevant imaging was reviewed. All cases were reviewed prior to a decision for surgery by the multidisciplinary craniofacial team (composed of neurosurgery, maxillofacial and plastics teams) and underwent surgery in our paediatric craniofacial centre.
Results:
Overall, 98 PCD cases were identified during the study period, of which 20 cases were identified as having undergone PCD at age 6 or above with mean age of 8.8 years (range 6-18). The most common indication was pansynostosis associated with raised intracranial pressure. Four cases had calvarial remodelling previously and represented with symptoms of raised intracranial pressure sometime after their initial surgery requiring PCD as rescue procedure. Average duration of inpatient stay was 5.85 days. The average duration of follow-up was 3.5 years (0.3 to 11 years). Mean distraction distance achieved was 22.5 mm (18-29 mm). Five patients experienced complications related to wound infection or distractor. Follow-up assessment in all patients demonstrated evidence of vault expansion and symptomatic improvement and resolution of intracranial pressure signs. Comparison with younger cohort did not reveal any difference in any parameters except lower rate of transfusion in the older cohort compared to young cohort (5% vs 38%).
Conclusion:
Posterior calvarial distraction in older children is safe and effective for vault expansion and treatment of raised intracranial pressure in selected cases. A multidisciplinary craniofacial team approach is crucial for appropriate case selection and management in order to optimise outcomes.
