Endoscopic posterior vault distraction osteogenesis (PVDO): advantages of eliminating the bicoronal incision

Cranial vault modeling for children with craniosynostosis is traditionally performed utilizing an open bicoronal approach. For patients with multi-suture craniosynostosis, particularly bilateral coronal suture fusion, posterior vault expansion using cranial springs or distractors is increasingly utilized. Posterior vault distraction osteogenesis (PVDO) enables substantial expansion of intracranial volume, minimizes relapse, and corrects cranial dysmorphology. However, the burden of a large bicoronal scar remains challenging for patients and families. Minimally invasive endoscopic approaches used primarily for single-suture craniosynostosis allow for decreased blood loss, shorter hospital stay, and decreased scar burden. However, minimally invasive techniques have not yet been realized for PVDO, for several reasons including the safe navigation of venous anatomy. In this report, the authors describe a novel technique utilizing a minimally invasive endoscopic PVDO technique (PV En-DO) that avoids a bicoronal incision and present an initial case report demonstrating feasibility in patients with bicoronal craniosynostosis. The authors conclude that PV En-DO appears feasible, safe, and effective, offering adequate cranial vault expansion with reduced scar burden and advantageous perioperative characteristics. Further study is needed to elucidate the indications, safety, and long-term outcomes of this technique.