The Trans-Sutural Distraction Osteogenesis for 22 Cases of Craniosynostosis: A New, Easy, Safe, and Efficient Method in Craniosynostosis Surgery

Abstract

Background: Distraction osteogenesis for the treatment of craniosynostosis is becoming more widely used as it is simple, there are less transfusions, and a decreased incidence of complications, although a secondary procedure for the removal of the distractors is necessary. However, to date all previous procedures have still been complicated. The authors present a novel trans-sutural distraction osteogenesis method (TSuDO) for the treatment of all types of craniosynostosis. Methods: The TSuDO consisted of simple suturectomy of the pathologic suture followed by direct distraction of the suturectomy site only. Types of TSuDO conducted were sagittal TSuDO in 6 patients, coronal TSuDO in 5 patients, unilateral coronal TSuDO in 8 patients, lambdoid TSuDO in 2 patients, and metopic TSuDO in 1 patient (total = 22). Mean age was 9.3 ± 12.7 months. Results: The mean operation time was 143.6 ± 50.2 min, and mean total transfusion volume of blood components was 131.1 ± 78.3 ml. Immediate correction of the abnormal head contour after distraction was observed in all patients, and no complications were encountered except for 1 patient whose distractor malfunctioned and 2 who showed prolonged discharges from the pin sites (controlled by antibiotics). Conclusion: TSuDO is a simple, effective, and safe method for the treatment of all types of craniosynostosis, and is especially effective for the correction of unilateral coronal craniosynostosis.

Transsutural distraction osteogenesis for 285 children with craniosynostosis: a single-institution experience

“…9,12,22 The male to female ratio showed a higher proportion of females with bicoronal and unilateral coronal craniosynostosis, which is similar to results in past studies. 12 Our patients with secondary craniosynostosis had lower mean gestational ages and mean birth weights, which we presume is a natural phenomenon due to overall brain and systemic underdevelopment.…”

“…LP pressure was shown to be particularly lower in children with secondary craniosynostosis after surgery. 21,22 In the present study, the subgroup of patients with LP pressures less than 20 cmH 2 O demonstrated no significant difference in operative time but significantly less mean total transfusion volume (p < 0.05) compared with those with greater than 20 cmH 2 O of LP pressure. We believe the reason for this difference in total transfusion volume is due to the increased volume of drainage via the extracranial pathway, which results from increased ICP, so that greater blood loss occurs when incising the scalp and removing the fused skull suture.…”

“…Comparison of previous mean operative times shows that while Lauritzen et al 12 reported a mean of 97-215 minutes for spring DO, Kim et al, 9 Park et al, 21 and Park et al 22 observed similar mean times of 248 minutes, 251 minutes, and 144 minutes, respectively, for the distractor DO procedure. The current study shows the shorter mean operative time of 115 minutes.…”

“…22 The spring DO procedure results in expansion of the cranium immediately after surgery, and therefore there is no latency period. Also, the distraction direction vector cannot be adjusted, and thus there is an increased risk of complications, such as bleeding, CSF leakage, subdural space widening, and unwarranted less expansion or overexpansion of the cranium with undesirable cosmetic consequences.…”

“…22 Therefore, surgical techniques for sagittal, coronal, and lambdoid suture craniosynostosis consisted of resection of the pathological suture and placement of the distractor followed by DO (Fig. 1).…”