Posterior Vault Distraction Osteogenesis for Craniosynostosis-Surgical Outcomes Over 12 Years.
Mohamed El-Nemr1, David Richardson, Christian Duncan
1Alder Hey Children's Hospital, Eaton Road, Liverpool, UK.
The Journal of Craniofacial Surgery
|December 27, 2024
Summary
Posterior vault distraction osteogenesis (PVDO) is safe and effective for increasing intracranial volume. However, it does not typically resolve pre-existing Chiari malformation type 1 (CM), especially in multisuture cases.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Posterior vault distraction osteogenesis (PVDO) increases intracranial volume but carries risks like CSF leaks, infection, and device failure.
- The impact of PVDO on pre-existing Chiari malformation type 1 (CM) requires further investigation.
Purpose of the Study:
- To evaluate the outcomes of PVDO over a 12-year period.
- To assess the effect of PVDO on patients with pre-existing Chiari malformation type 1 (CM).
Main Methods:
- Retrospective review of 51 PVDO procedures performed between 2011 and 2023.
- Analysis of complications, surgical outcomes, and the impact on CM in pediatric patients.
Main Results:
- PVDO demonstrated a low complication rate (82% no complications).
- Complications included dural tears (12%), CSF leaks (2%), infection (4%), and device failure (2%).
- 20% of patients had CM, primarily associated with multisuture synostosis (90% lambdoid involvement); CM remained unchanged post-PVDO in most cases.
Conclusions:
- PVDO is a safe and effective procedure with no repeat expansions needed over 12 years.
- PVDO does not typically resolve Chiari malformation type 1.
- Multisuture synostosis and Crouzon syndrome are high-risk groups for PVDO complications.
