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. 2023 Aug 16;11(8):e5208.
doi: 10.1097/GOX.0000000000005208. eCollection 2023 Aug.

Combined Dynamic Osteotomies for Craniosynostosis

Vera Lúcia N Cardim  1 , Geórgia M C Peres  1 , Alessandra Dos S Silva  1
Affiliations

Combined Dynamic Osteotomies for Craniosynostosis

Vera Lúcia N Cardim et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: In primary craniosynostosis, the premature fusion of one or more sutures prevents the perpendicular expansion of brain tissue (primary defect). Providing space for the brain to expand, the compensatory growth of unaffected sutures causes progressive skull deformation (secondary defect). Understanding the need to treat the osteogenic matrix responsible for the cranial vault's shape was essential to develop a novel surgical concept known as dynamic osteotomy. It uses springs to activate stenotic sutures and trigger dura-mater distension while flexibilizing compensatory osseous defects via helicoid osteotomy (nautilus technique), allowing for efficient bone expansion and remodeling in craniosynostosis.

Method: This case series describes patients with craniosynostosis treated with dynamic osteotomy utilizing structural transformation inductors such as springs and helicoid osteotomy (nautilus technique), operated on between July 2004 and January 2020 at a single center in Brazil.

Result: Dynamic osteotomy longitudinally achieved stable osseous remodeling during growth period while maintaining good vitality and continuity of the osteotomized cranial vault.

Conclusion: Dynamic osteotomy utilizing springs and nautilus technique, alone or in combination, is a successful treatment of craniosynostosis regardless of patient's age.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Dura mater Z-plasty postoperative aspect.
Fig. 2.
Fig. 2.
Long-term results of plagiocephaly operated on BTS and dura mater Z-plasty: A, Preoperative frontal view (2.5 years old); B, Frontal view, 7 years postoperative; C, Frontal view, 28 years postoperative. D, Preoperative basal view (2.5 years old). E, Basal view, 7 years postoperative. F, Basal view, 28 years postoperative.
Fig. 3.
Fig. 3.
Schematic and intraoperative photographs. A, Schematic representation of the expansion of the dura mater induced by the force applied to the bone. B, STI springs forming omega shape for expansion. C, Two STI springs for compression.
Fig. 4.
Fig. 4.
Surgery distribution by type of dynamic osteotomy used.
Fig. 5.
Fig. 5.
Distribution of number of cases (vertical) according to Whitaker classification (horizontal—in I/II/III/IV) according of affected suture.
Fig. 6.
Fig. 6.
Cascade of events leading to craniosynostosis intraoperative view.
Fig. 7.
Fig. 7.
Intraoperative view: detail of absorbable helicoid pads for compression (yellow arrows).
See this image and copyright information in PMC

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