Cranial Vault Distraction in Nonsyndromic Sagittal Synostosis

Abstract

A multitude of operations exists for the treatment of patients with sagittal craniosynostosis presenting after 6 months of age, of which total cranial vault remodeling now provides the most reliable aesthetic outcome. As our national craniofacial center evolved and began to develop a comprehensive multi-disciplinary team to manage complex surgical cases, we offered cranial vault distraction as an alternative to more invasive surgery for late presentation nonsyndromic scaphocephaly. The authors conducted a retrospective review of all patients undergoing this procedure.An average distraction distance of 39.4 mm was achieved in 15 patients aged 1 to 9 years. As a result, the cephalic index changed an average of 4%. The mean transfusion volume in the perioperative period was 32.47% of estimated blood volume. There were 2 complications requiring further operative intervention and distraction was stopped early in 1 patient.The authors propose that internal calvarial distraction is a viable alternative to total cranial vault remodeling for the management of late presentations of sagittal craniosynostosis.

Late Presenting Sagittal Craniosynostosis: An Update to a Standardized Treatment Protocol

“…29 Quinlan et al present a less invasive approach for patients older than 1 year, opting for cranial vault distraction as an alternative to more invasive surgery; however, two of their 15 patients required a reoperation. 26 In our experience, this population of patients presents with heterogeneous abnormalities that warrant specific and nuanced surgical techniques, particularly in older patients. As a result, we take a "deformity-targeted approach" most similar to that proposed by Weinzweig et al, in which the selection of each operation is tailored to address the specific needs of the patient.…”

“…29 Quinlan et al present a less invasive approach for patients older than 1 year, opting for cranial vault distraction as an alternative to more invasive surgery; however, two of their 15 patients required a reoperation. 26…”

“…Although reconstruction of sagittal craniosynostosis within the first year of life takes advantage of increased healing potential of the infant skull and dura, various surgical techniques for the correction of sagittal craniosynostosis at a later age have also been investigated. 17,[24][25][26][27][28][29][30] The potential increase in intracranial volume after surgical reconstruction is reduced in older patients compared with younger patients with sagittal craniosynostosis. 30 Hudgins et al first presented a technique of total calvarial reconstruction to shorten the anteroposterior length, widen the biparietal diameter, and address frontal and occipital abnormalities.…”