Posterior calvarial distraction in craniosynostosis – An evolving technique

Wiberg, Akira; Magdum, Shailendra; Richards, Peter G.; Jayamohan, Jayaratnam; Wall, Steven A.; Johnson, David

doi:10.1016/j.jcms.2012.02.018

Cited by 45 publications

(32 citation statements)

References 20 publications

(26 reference statements)

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“…11,19 Finally, some studies report an improvement and decompression of Chiari malformations after PVDO due to the volume increase of the posterior cranial base. [8][9][10][11][12][13][14][15][16][17][18] Several valid criticisms of PVDO are already in the literature. The ability to reshape the posterior vault in multiple dimensions with PVDO is limited.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7] Recent reports have demonstrated the benefits of posterior vault distraction osteogenesis (PVDO) as a potential first stage, citing greater increases in intracranial volume relative to FOA, a decrease in soft tissue complications, an improvement of the turribrachycephaly, a decrease in the overall number of surgical procedures/revisions by delaying the timing of the anterior vault surgery, and an improvement in Chiari malformations. [8][9][10][11][12][13][14][15] The obvious downside to PVDO is the need for a second procedure for device removal.A less obvious, but growing, concern with PVDO is that it may induce craniosynostosis posteriorly, although this has not been documented in the literature. The purposes of this study were to document the incidence of new-onset craniosynostosis (NOC) after PVDO, to determine risk factors for the development of NOC, and to deduce the cranial ramifications of NOC.…”

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confidence: 99%

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New-Onset Craniosynostosis After Posterior Vault Distraction Osteogenesis

Tahiri¹,

Paliga²,

Bartlett³

et al. 2015

Journal of Craniofacial Surgery

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The aims of this study were to document the incidence of new-onset craniosynostosis (NOC) after posterior vault distraction osteogenesis (PVDO), to determine risk factors for the development of NOC, and to deduce the cranial ramifications of NOC. An institutional review board-approved retrospective review of all patients who underwent PVDO at the Children's Hospital of Philadelphia was performed. Demographics, perioperative data, as well as preoperative and postoperative three-dimensional computed tomographic scans were analyzed. Suture patency preoperatively and postoperatively was recorded.Thirty patients underwent PVDO for suspected increased intracranial pressure and/or severe turribrachicephaly from 2008 to 2013. Twenty-four patients had syndromic diagnoses. The average age at the time of PVDO was 2.03 years. Distraction distances ranged from 19 to 40 mm, with an average of 28.7 mm. Among the 19 patients who had patent lambdoid sutures before PVDO, new-onset lambdoid fusion was seen in 17 patients after PVDO (89.5%), whereas the suture remained open in 2 patients (10.5%). New-onset lambdoid fusion was not significantly associated with age at distraction (P = 0.28), sex (P = 0.47), length of distraction (P = 0.93), or diagnosis (P = 0.61). Similarly, new-onset sagittal synostosis was not associated with age at distraction (P = 0.06), sex (P = 0.64), length of distraction (P = 0.83), or diagnosis (P = 0.25). None of the patients who developed NOC had characteristic head shape changes such as mastoid bulges or scaphocephaly. New-onset lambdoid and sagittal synostoses occur frequently after PVDO. Although the diagnosis of NOC is obvious radiographically, the clinical importance of the diagnosis morphometrically, neurodevelopmentally, and in cranial growth has yet to be fully investigated.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

New-Onset Craniosynostosis After Posterior Vault Distraction Osteogenesis

Tahiri¹,

Paliga²,

Bartlett³

et al. 2015

Journal of Craniofacial Surgery

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“…Considerable literature now describes its safety [5][6][7][8][9][10][11][12][13][14][15] and ability to convey robust cranial expansion. 7,8,12 However, there is still limited understanding of its impact on cranial morphology and aesthetics, or how it may best fit in the care paradigm for syndromic synostosis.…”

mentioning

confidence: 99%

An Algorithm for Managing Syndromic Craniosynostosis Using Posterior Vault Distraction Osteogenesis

Swanson

Samra

Bauder

et al. 2016

Plastic &Amp; Reconstructive Surgery

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“…In another report, they contended that early removal of the distractors can also decrease device-related complications and the burden of care in patients [16]. Moreover, Wiberg et al [20] also reported that a short consolidation period, i.e., <1 month, was enough to form a complete bony bridge, and they questioned whether a prolonged consolidation phase is required for successful ossification.…”

Section: Discussionmentioning

confidence: 99%

“…The dura mater in young children has osteogenic potential, and this should allow for a reduced consolidation period [13,16]. Moreover, the brain itself underneath the skull can act as splint [20]. Lastly, the skull is neither a movable nor a weight-bearing bony structure.…”

Section: Discussionmentioning

confidence: 99%