Morphometric analysis and outcomes following posterior cranial vault distraction in syndromic and multisuture craniosynostosis

Al-Shaqsi, Sultan; Ching, Jessica A.; Novak, Christine B.; Forrest, Christopher R.

doi:10.1016/j.bjps.2023.10.101

Cited by 3 publications

(2 citation statements)

References 22 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%

“…Preoperative fine-cut (1 mm or less) head CT scans were analyzed on Mimics Version 23.0 (Materialise, Leuven, Belgium) to evaluate baseline morphometrics. Five linear distances [27], frontal bossing angle [11,28], and turricephaly index [29,30] were measured. Distances included cranial width, cranial length, and three cranial heights (anterior, middle, and posterior) (Supplemental Fig.…”

Section: Craniometricsmentioning

confidence: 99%

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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%

Section: Craniometricsmentioning

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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Posterior Cranial Vault Distractor Osteogenesis for the Treatment of Chiari Malformation Type 1: A Systematic Review of the Literature

Cobb,

Pan,

Zhu

et al. 2024

Journal of Craniofacial Surgery

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Background: Although posterior cranial vault distraction osteogenesis (PVDO) is utilized routinely now for the treatment of craniosynostosis, its use as a treatment option for Chiari type 1 malformation (CM1) is limited to case reports and small retrospective case series. Methods: The authors conducted a systematic review of the published literature for PVDO as a treatment for CM1. The primary outcomes were reported complications, symptom improvement, and reoperation rates in patients that had PVDO surgery for CM1. The authors further investigated differences between patients with CM1 with an associated genetic syndrome and craniosynostosis. Results: In total, 42 patients with an average age of 41.1 months were used in our analysis. A total of 38.1% of the patients had a diagnosed syndrome, 78.6% of patients had associated craniosynostosis, and 26/42 (61.9%) total patients-reported symptom improvement. Of 26 patients that reported symptom improvement, 20 (76.9%) had associated syndromes and 6 (23.1%) did not (P=0.011). In addition, of these 26 symptom improved patients, 17 (65.4%) were associated with craniosynostosis while 9 (36.4%) did not have craniosynostosis (P=0.008) Conclusions: Posterior cranial vault distraction osteogenesis seems to be a promising new surgical intervention for treatment of CM1. Most patients saw symptom improvement after treatment (61.9%). There was a clinically and statistically significant difference in symptom improvement for patients with syndromic CM1 when compared with nonsyndromic CM1 patients.

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Management of Coincident Metopic and Unilateral Lambdoid Craniosynostosis, a Rare Entity

Daly,

Ferry,

Howell

et al. 2024

FACE

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Introduction: Multi-suture craniosynostosis is rare and comprises only 3% to 7% of all craniosynostosis cases. Depending on the sutures involved, there are multiple operative approaches for this disease. In this report, we describe the staged surgical management of a patient who presented with metopic and unilateral lambdoid synostosis with initial posterior cranial vault remodeling followed by fronto-orbital advancement (FOA). Methods: At our institution, case reports detailing a single patient are not considered human research by the Institutional Review Board and official approval was not sought. Written consent for inclusion of patient information and images was obtained from the patient’s legally authorized representative. Results: A male patient was treated for metopic and right unilateral lambdoid synostosis. Physical examination was notable for trigonocephaly, right sided posterior plagiocephaly, right mastoid bulging, and contralateral parietal bossing. Treatment of his synostotic deformities was delayed and treated in stages. This was achieved with initial posterior vault expansion, to treat his lambdoid synostosis, via a modification to the classic switch cranioplasty at 5 months of age. The patient subsequently underwent fronto-orbital advancement for correction of metopic synostosis at 10 months of age. The posterior cranial vault remodeling procedure permitted sufficient cranial vault expansion to delay fronto-orbital advancement until 10 months of age. Of note, excellent bone fill and union were observed of the posterior bone grafts at the time of scalp flap elevation during this second procedure. His most recent follow up appointment at 11 months status post FOA demonstrated continued deformational correction as well as good bone fill and wound healing. Conclusions: Multi-suture craniosynostosis is rare with only a single other report in the literature discussing concurrent metopic and unilateral lambdoid synostosis. A multi-stage approach is the most commonly employed technique and must be tailored to each patients’ unique presentation.

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Morphometric analysis and outcomes following posterior cranial vault distraction in syndromic and multisuture craniosynostosis

Cited by 3 publications

References 22 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 Vault Distractor Osteogenesis for the Treatment of Chiari Malformation Type 1: A Systematic Review of the Literature

Management of Coincident Metopic and Unilateral Lambdoid Craniosynostosis, a Rare Entity

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