Posterior cranial vault expansion using distraction osteogenesis

Derderian, Christopher A.; Bastidas, Nicholas; Bartlett, Scott P.

doi:10.1007/s00381-012-1802-0

Cited by 51 publications

(30 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

mentioning

confidence: 99%

See 1 more Smart Citation

New-Onset Craniosynostosis After Posterior Vault Distraction Osteogenesis

Tahiri¹,

Paliga²,

Bartlett³

et al. 2015

Journal of Craniofacial Surgery

Self Cite

View full text Add to dashboard Cite

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.

show abstract

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

Self Cite

View full text Add to dashboard Cite

show abstract

“…Other centers have strongly advocated the use of early posterior cranial vault distraction followed by an FOA in bilateral coronal craniosynostosis, and they cite the benefits of early release of cranial restriction and improved morphology due to the cessation of the development of turricephaly. 5,21,24,25,27 Similarly, endoscopic suture release allows safe, early release of restricted cranial growth but addresses the site of pathology directly. This treatment therefore offers the patient the chance of treatment with a single operation and avoids an algorithm that requires 3 operations (osteotomy and device placement, device removal, and ultimate FOA).…”

Section: 2125mentioning

confidence: 99%

“…This has resulted in the current practice of early posterior cranial vault distraction, where enlargement of the unaffected posterior vault is used to increase cranial volume early in an attempt to alleviate elevated ICP and the development of turricephaly. 5,21,24,25,27 This procedure is then followed by a delayed frontal advancement.…”

mentioning

confidence: 99%

Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis

Rottgers

Lohani

Proctor

2016

PED

View full text Add to dashboard Cite

OBJECTIVE Historically, bilateral frontoorbital advancement (FOA) has been the keystone for treatment of turribrachycephaly caused by bilateral coronal synostosis. Early endoscopic suturectomy has become a popular technique for treatment of single-suture synostosis, with acceptable results and minimal perioperative morbidity. Boston Children's Hospital has adopted this method of treating early-presenting cases of bilateral coronal synostosis. METHODS A retrospective review of patients with bilateral coronal craniosynostosis who were treated with endoscopic suturectomy between 2005 and 2012 was completed. Patients were operated on between 1 and 4 months of age. Hospital records were reviewed for perioperative morbidity, length of stay, head circumference and cephalic indices, and the need for further surgery. RESULTS Eighteen patients were identified, 8 males and 10 females, with a mean age at surgery of 2.6 months (range 1–4 months). Nine patients had syndromic craniosynostosis. The mean duration of surgery was 73.3 minutes (range 50–93 minutes). The mean blood loss was 40 ml (range 20–100 ml), and 2 patients needed a blood transfusion. The mean duration of hospital stay was 1.2 days (range 1–2 days). There was 1 major complication in the form of a CSF leak. The mean follow-up was 37 months (range 6–102 months). Eleven percent of nonsyndromic patients required a subsequent FOA; 55.6% of syndromic patients underwent FOA. The head circumference percentiles and cephalic indices improved significantly. CONCLUSIONS Early endoscopic suturectomy successfully treats the majority of patients with bilateral coronal synostosis, and affords a short procedure time, a brief hospital stay, and an expedited recovery. Close follow-up is needed to detect patients who will require a secondary FOA due to progressive suture fusion or resynostosis of the released coronal sutures.

show abstract

“…e A recent image from 12 months after the first operation shows a good cosmetic outcome and the improvement of digital marks greater movement to be achieved [17]. In addition, maintenance of the bone flap's vascularity can aid in new bone formation and reduce the risk of infection of the skull [6]. For all these reasons, the clinical application of DO has been increased, and accordingly, DO is selected in many cases as the first line of treatment for procedures such as correction of craniosynostosis and skull deformities causing increased intracranial pressure.…”

Section: Discussionmentioning

confidence: 97%