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.
Insights
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.
Introduction:
Posterior vault distraction osteogenesis (PVDO) allows significant increase in intracranial volume but is associated with complications including cerebrospinal fluid (CSF) leaks, infection and device failure. The authors outline their outcomes over 12 years and the impact of PVDO on pre-existing Chiari malformation type 1 (CM).
Method:
Retrospective review of all PVDOs in our unit over a period of 12 years from 2011 to 2023. Results: 51 patients. The mean age of surgery 9 months. The mean length of follow-up 72 months. 82% no complications, 12% dural tear with 2% CSF leak; 4% infection, 2% device failure, 10% blood transfusion. CM in 20% of patients-all are multisuture with 90% lambdoid synostosis involvement. CM is unchanged in the majority of patients post-PVDO.
Conclusion:
PVDO safe and effective with no re-do posterior vault expansions over 12 years. CM does not tend to resolve after PVDO and high-risk groups include multisuture and Crouzons.
