Iatrogenic syringomyelia postcranial surgery in pediatric patients: systematic review and illustrative case

Kurzbuch, Arthur R.; Magdum, Shailendra

doi:10.1007/s00381-021-05268-8

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…For patients without turribrachycephaly, as most of ours were, a posteriorly oriented distraction vector would create a scaphocephalic appearance. Furthermore, Lo et al,14 along with other recent reports, found that PVDO decreased intracranial pressure and increased intracranial volumes in patients with pansynostosis, lambdoid synostosis, and syringomyelia 15–17. Park et al18 corroborated this finding, as Park et al18 described decreased intracranial pressure and expanded posterior fossa volumes in patients with craniosynostosis who were treated with PVDO with distraction in the posterior to the inferior-posterior direction.…”

Section: Discussionmentioning

confidence: 80%

“…Furthermore, Lo et al, 14 along with other recent reports, found that PVDO decreased intracranial pressure and increased intracranial volumes in patients with pansynostosis, lambdoid synostosis, and syringomyelia. [15][16][17] Park et al 18 corroborated this finding, as Park et al 18 described decreased intracranial pressure and expanded posterior fossa volumes in patients with craniosynostosis who were treated with PVDO with distraction in the posterior to the inferior-posterior direction. We submit that vertically oriented distraction osteogenesis of the posterior cranial vault achieves the symptomatic goals of traditional posterior vault expansion with decreased risk for cerebellar ptosis.…”

Section: Discussionmentioning

confidence: 90%

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Inferiorly Directed Posterior Cranial Vault Distraction for Treatment of Chiari Malformations

Hazkour

Atamian

et al. 2022

Journal of Craniofacial Surgery

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Objective: The authors present a case series of patients with Chiari I malformations treated with distraction osteogenesis of the posterior cranial vault, utilizing a vertical distraction vector for appropriate cranial vault expansion while mitigating the risks of scaphocephaly and cerebellar ptosis. Patients and Methods: Patients with syndromic and nonsyndromic Chiari I malformations treated with vertical-vector distraction osteogenesis of the posterior cranial vault were identified from 2008 to 2014. Demographics, preoperative and postoperative clinical symptoms, and perioperative details were assessed. Long-term esthetic outcomes, complications, and symptomatic improvement were evaluated in conjunction with neurosurgery.Results: Nine patients were identified. Five had known syndromes, 2 likely had unidentified syndromes, and 2 were nonsyndromic. Seven had prior Chiari-related surgeries. Most presented with hydrocephalus, motor symptoms, and developmental delay. Operatively, 2 to 3 internal distraction fixators were applied such that the vector of distraction was along a cephalad-caudad axis. Devices were activated on postoperative day 5 and distracted 1 mm per day. Three postoperative complications were found within the first 3 months which included a dislodged distraction arm, a device extrusion, and a local cellulitis. No complications affected the clinical outcome. Radiographic follow-up showed good bone formation, decompression of the posterior fossa, improved cerebrospinal fluid flow, and no cerebellar ptosis. Neurological surveillance showed improvement in intracranial pressure, hydrocephalus, motor symptoms, and behavioral problems. Conclusion:The authors have presented 9 patients with Chiari I malformations treated with distraction osteogenesis, along with a novel technique to safely and effectively expand the posterior fossa while minimizing the risk of cerebellar ptosis.Level of Evidence: Level II (prognostic/risk studies).

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