Posterior cranial vault distraction osteogenesis: A systematic review

Area of Science:

• Neurosurgery
• Pediatric Surgery
• Craniofacial Surgery

Background:

• Posterior cranial vault distraction osteogenesis (PCVDO) is increasingly used for craniosynostosis to prevent intracranial hypertension.
• Evidence on the safety of PCVDO, particularly regarding proximity to the torcula, is limited.

Purpose of the Study:

• To systematically review and generate evidence on the safety of posterior cranial vault distraction osteogenesis (PCVDO).
• To assess complications, volume gain, and distraction protocols in PCVDO for craniosynostosis.

Main Methods:

• A systematic literature search of PubMed and Embase databases was conducted up to July 31, 2021.
• Eleven articles detailing 242 PCVDO procedures in 241 patients were included for analysis.

Main Results:

• The overall complication rate for PCVDO was 30.6%, with wound infection being the most frequent complication.
• PCVDO achieved a 20-25% cranial vault volume gain and effectively prevented increased intracranial pressure.
• No mortality was directly attributed to the PCVDO procedure.

Conclusions:

• PCVDO demonstrates a significant complication incidence but no direct mortality, indicating a need for continued safety monitoring.
• The evolution of customized osteotomy designs and vectors contributes to safer PCVDO procedures.
• Further observational studies are needed to understand the effects of PCVDO on the anterior cranial fossa.