Craniosynostosis and Chiari I Malformation Managed With Middle 1/3 Calvarial Vault Expansion

Area of Science:

• Neurosurgery
• Pediatric Neurosurgery
• Craniofacial Surgery

Background:

• Craniosynostosis, particularly multisutural syndromic forms, is linked to secondary Chiari malformation.
• Single suture synostosis can also cause Chiari malformation due to craniocephalic disproportion.
• Traditional posterior vault expansion may worsen scaphocephaly in sagittal synostosis and may be insufficient for Chiari malformation in growing children.

Purpose of the Study:

• To describe the successful use of the Pi-Hung Span procedure for middle 1/3 vault expansion in 3 pediatric cases.
• To evaluate the efficacy of this technique in treating craniosynostosis with concurrent Chiari malformation.
• To assess the impact on scaphocephaly and tonsillar herniation.

Main Methods:

• The study involved 3 pediatric patients with craniosynostosis (2 isolated sagittal, 1 sagittal with partial lambdoid) and Chiari malformation.
• Treatment utilized the Pi-Hung Span procedure for middle 1/3 vault expansion.
• Follow-up ranged from 6 to 18 months, assessing clinical symptoms and radiographic evidence of tonsillar herniation.

Main Results:

• All 3 patients showed symptomatic improvement following the Pi-Hung Span procedure.
• Radiographic evaluation demonstrated improvement in tonsillar herniation in all treated patients.
• The procedure avoided craniotomy over the torcular and transverse sinus, reducing the risk of sinus injury.

Conclusions:

• Middle 1/3 vault expansion using the Pi-Hung Span procedure is a viable surgical option for children with Chiari malformation secondary to craniosynostosis.
• This technique effectively addresses craniocephalic disproportion and prevents worsening scaphocephaly.
• It offers a comprehensive reconstruction for overall anatomic disproportion during skull growth, improving neurodevelopmental outcomes.