Early Posterior Vault Distraction Osteogenesis for the Treatment of Syndromic Craniosynostosis

Johns, Dana; Anstadt, Erin; Donato, Daniel P.; Kestle, John R. W.; Riva-Cambrin, Jay; Siddiqi, F.; Gociman, Barbu

doi:10.1055/s-0036-1582455

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…Nonetheless, our assessment of preoperative craniometric parameters validates the comparability between treatment cohorts, while our subgroup analysis of patients optimally presenting before age one corroborates our conclusions. While other centers have advocated for PVDO as the primary intervention for syndromic craniosynostosis with favorable outcomes [4,5,30,42,43], none have provided follow-up beyond a few years postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Early posterior vault distraction osteogenesis changes the syndromic craniosynostosis treatment paradigm: long-term outcomes of a 23-year cohort study

Wu,

Barnett,

Massenburg

et al. 2024

Childs Nerv Syst

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Background Early surgical management of syndromic craniosynostosis varies widely between centers, with patients typically undergoing multiple intracranial procedures through childhood. This study evaluates the long-term impact of early posterior vault distraction osteogenesis (PVDO) versus conventional treatment paradigms on the number and timing of subsequent craniofacial procedures. Methods We retrospectively analyzed the longitudinal operative patterns of patients with syndromic craniosynostosis treated from 2000 to 2023 with greater than five years of follow-up. Outcomes of patients who underwent early PVDO and conventional vault reconstruction were compared. Results Fifty-five patients met the inclusion criteria (30 PVDO and 25 conventional). Age at initial vault surgery was similar between the PVDO and conventional cohorts (7.6 vs. 8.8 months), as were baseline craniometrics (p > 0.05). Multiple fronto-orbital advancement (FOA) procedures were performed in only 1/30 (3%) PVDO-treated patient versus 12/25 (48%) conventionally-treated patients (p < 0.001). Twelve (40%) PVDO-treated patients did not undergo FOA at all. Among patients with Apert and Crouzon syndromes, fewer PVDO-treated patients required FOA prior to midface surgery (33% vs. 92%, p = 0.004) or repeat FOA (6% vs. 50%, p = 0.005) compared to conventionally-treated patients. Among patients with Muenke and Saethre–Chotzen syndromes, a similar proportion of patients required FOA in the PVDO and conventional cohorts (91% vs. 100%, p = 0.353), though no PVDO-treated patients required repeat FOA (0% vs. 44%, p = 0.018). Conclusions Early PVDO is associated with a reduction in the high burden of both FOA and, critically, revisionary frontal procedures which are commonly seen in conventionally-treated patients with syndromic craniosynostosis.

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Section: Discussionmentioning

confidence: 99%

Early posterior vault distraction osteogenesis changes the syndromic craniosynostosis treatment paradigm: long-term outcomes of a 23-year cohort study

Wu,

Barnett,

Massenburg

et al. 2024

Childs Nerv Syst

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“…Sixteen studies representing 307 subjects detailed postoperative complications. [8][9][10][11][12][13][14][15][16][17][18][19][20][21]23,25 The overall complication rate in those studies was 32.2% (Figure 2). The most common complication was surgical-site infection (10.7%), followed by hardware failure/fracture/dislodgement (8.5%), delayed wound healing (6.2%), persistent cerebrospinal fluid leak (5.5%), significant hemorrhage (0.7%), meningitis (0.3%) and death (0.3%).…”

Section: Surgical Outcomesmentioning

confidence: 94%

Posterior Cranial Distraction in Craniosynostosis: A Systematic Review of the Literature

Khansa

Drapeau

Pearson

2023

The Cleft Palate Craniofacial Journal

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Objective Posterior cranial distraction (PCD) is a surgical technique to address craniosynostosis, especially in syndromic patients. The technique has the ability to significantly expand the cranium, while requiring minimal dural dissection, compared to cranial remodeling. Our goals were to determine the patient characteristics and surgical outcomes of PCD. The two questions that we sought to answer were: 1) What is the average published complication rate and the most common complications of PCD? and 2) How much intracranial volume expansion can one expect with PCD? Design A PubMed database search of articles on PCD was performed. Case reports and articles with overlapping patients were excluded. A systematic review was performed using the remaining articles. Main Outcome Measures Patient data were extracted in order to determine the total number of patients, patients with a syndrome, types of syndromes, mean age at surgery, mean distraction distance, mean increase in intracranial volume, and complications. Results 18 articles representing 325 patients were analyzed. A syndrome was present in 68.6% of patients. The mean age at time of surgery was 22.1 months. Mean distraction amount was 24.7 mm. Mean increase in intracranial volume was 253.2 cm3. The overall complication rate was 32.2%, with the most common complications being surgical-site infection, hardware-related complications and delayed wound healing. Conclusions PCD is a powerful technique in the management of syndromic craniosynostosis, although complication rates are significantly higher than traditional remodeling techniques. Future studies should compare the effects of supratorcular and infratorcular osteotomies on intracranial volume, cosmesis and complications.

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“…Studies were excluded if not in English and not within the last 30 years. A total of 24 studies were included in our systematic review of distraction protocol for PVDO 4,5,7,8,12,14–34 . The search was in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines (Fig.…”

Section: Methodsmentioning

confidence: 99%

A Review on Variability in Treatment Protocols With Posterior Cranial Vault Distraction

Sanati-Mehrizy

Graziano

Sayegh

et al. 2021

Journal of Craniofacial Surgery

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segments from their abnormal insertions and their approximation to one another does not lengthen the lip. In his technique, however, the muscle is released and then ''segmented'' to achieve length. It does not rely on measurements or skin flaps, and it can be used to close any degree of unilateral cleft lip cleft. The cleft borders on either side are excised and the orbicularis oris muscle is liberated from the surrounding tissues. After freeing them from the skin and mucosa, they are segmented and repositioned down toward the free border of the lip. He argues that lip length results from the orbicularis oris muscle repair and not from skin flaps. Although possible, its effect in real patients may be subject to question. Unfortunately, the anatomic, functional, and esthetic results of the lip closure have not been subjected to critical analysis with measured photographs. It would certainly be interesting, based on Dr Navarro's experience, to subject his preoperative and postoperative photographs to careful, measured review.

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Early Posterior Vault Distraction Osteogenesis for the Treatment of Syndromic Craniosynostosis

Cited by 7 publications

References 14 publications

Early posterior vault distraction osteogenesis changes the syndromic craniosynostosis treatment paradigm: long-term outcomes of a 23-year cohort study

Early posterior vault distraction osteogenesis changes the syndromic craniosynostosis treatment paradigm: long-term outcomes of a 23-year cohort study

Posterior Cranial Distraction in Craniosynostosis: A Systematic Review of the Literature

A Review on Variability in Treatment Protocols With Posterior Cranial Vault Distraction

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