Experience with craniosynostosis treatment using posterior cranial vault distraction osteogenesis

Abstract

Background: Craniosynostosis compromises the cranial vault volume, severely impede growth, and may lead to increased intracranial pressure (ICP). Posterior cranial vault (PCV) distraction osteogenesis (DO) offers an excellent treatment opportunity for this condition. This article intends to describe the outcomes of PCV DO.

Materials and methods: Nine males and seven female children indicated for PCV DO were included in the study. The single vector distraction devices with quick-disconnect distraction rods, a type of miniaturized hardware, was used in all cases.

Result: Seven of the 16 patients had a history of one or more prior cranioplasty. All reoperations in this series were performed for the indication of raised ICP including five of the scaphocephaly patients and the syndromic patients. Clinical signs of raised ICP were present in all patients with either measured raised intracranial pressure or those with clinical signs of raised ICP preoperatively. There was substantial decrease in the ICP postoperatively.

Discussion: The outcomes of this study were encouraging. Placing the distractor stems as flat as possible against the outer layer of the cranial bone seems to be a very important maneuver. This keeps the distractor stem less proud and less likely to sustain future trauma. Removal of the distractor stems keeps the devices further away from the risk of later traumatic dislodgement. Moreover, miniaturized distractors allow precise control of the rate and the amount of distraction.

Keywords: Craniosynostosis; distraction; intracranial pressure; posterior cranial vault distraction osteogenesis.

Figure 1

Clinical intraoperative photograph showing distractors in position on cranium with gap of 3 mm at the time of distractor placement surgery

Figure 2

Plain lateral skull radiograph at end of distraction showing posterior displacement of the cranial flap

Figure 3

Plain lateral skull radiograph at time of distractor rod removal with distractor left in to provide retention during consolidation phase

Figure 4

Preoperative radiograph of patient with raised ICP and digital impressions both in anterior cranial fossa and posterior regions

Figure 5

Radiograph following distractor stem removal during consolidation phase showing resolution of digital impressions