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Spring-assisted posterior vault expansion in children over 2 years of age with craniosynostosis
Karin Säljö1, Madiha Bhatti-Søfteland2, Peter Tarnow2
1Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden. karin.saljo@vgregion.se.
Insights
Spring-assisted posterior vault expansion (SA-PVE) is a safe and effective surgical treatment for children over 2 years old with craniosynostosis and high intracranial pressure (ICP). This procedure significantly increases intracranial volume, improving ICP-related symptoms.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Craniosynostosis can lead to elevated intracranial pressure (ICP) in children.
- Surgical intervention is often necessary to manage these conditions.
Purpose of the Study:
- To evaluate the safety and efficacy of spring-assisted posterior vault expansion (SA-PVE).
- To assess SA-PVE in children over 2 years old with craniosynostosis and signs of high ICP.
Main Methods:
- Retrospective analysis of patients aged >2 years undergoing SA-PVE between 2018-2020.
- Involved creating a large occipital bone flap attached to the dura, including the torcula.
- Intracranial volumes (ICVs) calculated from CT scans; ICP symptoms and demographic data collected.
Main Results:
- Eight patients included (Crouzon/Pfeiffer, multiple, secondary synostosis).
- Median ICV increase of 206 cm³ (18.7%, p=0.01) with no major perioperative complications.
- Symptoms related to high ICP improved or resolved post-surgery.
Conclusions:
- SA-PVE with a large occipital bone flap is a safe and effective surgical option.
- The procedure is suitable for children over 2 years old experiencing craniosynostosis with elevated ICP.
- Significant increase in intracranial volume was achieved, leading to clinical improvement.
Background:
This study evaluated spring-assisted posterior vault expansion (SA-PVE) in children aged > 2 years with craniosynostosis and signs of high intracranial pressure (ICP).
Methods:
We retrospectively analysed all consecutive patients aged > 2 years and operated with SA-PVE between 2018 and 2020 at the Craniofacial Center at Sahlgrenska University Hospital, Sweden. During the procedure, a circumferent occipital bone flap extending below the torcula was created and remained attached to the dura. Intracranial volumes (ICVs) were calculated from computed tomography (CT) images, and demographic data and information regarding symptoms and signs of high ICP were collected.
Results:
The study included eight patients [Crouzon/Pfeiffer (n = 4), multiple craniosynostosis (n = 3), and secondary synostosis (n = 1)]. Median age at SA-PVE was 3.8 years (range: 2.5-12.8 years), and springs were removed after a median of 5.5 months (range: 2.3-8.3 months). The median operating time was 164 min (range: 102-221 min), and estimated blood loss was 4.5 mL/kg body weight (range: 1.4-59.1 mL/kg body weight), with 50% of patients receiving a blood transfusion. The median increase in ICV was 206 cm3 (range: 122-344 cm3) representing an 18.7% increase (range: 7.9-24.1%; p = 0.01). We observed no major perioperative complications, and symptoms related to high ICP were improved or absent at clinical follow-up.
Conclusion:
These results demonstrated that SA-PVE involving creation of a large occipital bone flap including the torcula as a safe and effective surgical treatment in children aged >2 years with craniosynostosis and elevated ICP.
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