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Cranial vault distraction

Gökhan Tunçbilek, Ersoy Konaş, Mert Çaliş, Galip Gencay, Burçak Bilginer
Fronto-orbital advancement using distraction techniques involves the dura left attached to the osteotomized bone segment to avoid dead space formation and dural injury, whereas it is impossible to reshape the supraorbital bar and the frontal bone complex, when necessary. Our approach combines advantageous parts of conventional and distraction osteogenesis techniques as remodel and distract the supraorbital bar and frontal bone complex as a free bone graft. Twenty-seven patients either being syndromic and nonsyndromic craniosynostosis, with at least 3 years of follow-up were reviewed in this study...
July 7, 2017: Journal of Craniofacial Surgery
Jesse A Taylor, Scott P Bartlett
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the role of prenatal screening and counseling of parents of unborn children with syndromic craniosynostosis. 2. Recognize the genetic abnormalities, craniofacial phenotype, associated anomalies, and challenges associated with each of the five major forms of syndromic craniosynostosis. 3. Identify the pros and cons associated with timing and types of cranial vault remodeling techniques in this patient population...
July 2017: Plastic and Reconstructive Surgery
Rachel Gray, Alexander Gougoutas, Vinh Nguyen, Jesse Taylor, Nicholas Bastidas
OBJECTIVE: Virtual Surgical Planning (VSP) and computer-aided design/computer-aided manufacturing (CAD/CAM) have recently helped improve efficiency and accuracy in many different craniofacial surgeries. Research has mainly focused on the use in the adult population with the exception of the use for mandibular distractions and cranial vault remodeling in the pediatric population. This study aims to elucidate the role of VSP and CAD/CAM in complex pediatric craniofacial cases by exploring its use in the correction of midface hypoplasia, orbital dystopia, mandibular reconstruction, and posterior cranial vault expansion...
June 2017: International Journal of Pediatric Otorhinolaryngology
Niina Salokorpi, Ville Vuollo, Juha-Jaakko Sinikumpu, Leonid Satanin, Heleia Nestal Zibo, Leena P Ylikontiola, Pertti Pirttiniemi, George K Sándor, Willy Serlo
BACKGROUND: Posterior cranial vault distraction (PCVD) is a technique widely used in surgical treatment of craniosynostosis when cranial expansion is required. It has proven to be safe and to allow a significant increase of intracranial volume. OBJECTIVE: To evaluate increases in intracranial volume as a result of PCVD performed in Oulu Craniofacial center using 2 different methods based on 3-dimensional (3-D) photogrammetric imaging or plain skull radiographs. METHODS: All children less than 16 yr of age who were treated by PCVD (n = 31) from 2009 to 2015 at the Oulu Craniofacial Center were included...
April 5, 2017: Neurosurgery
Shoichi Tomita, Takeshi Miyawaki, Yuichirou Nonaka, Shinsuke Sakai, Reiji Nishimura
There are many surgical techniques for craniosynostosis. However, the indications for and timing of surgery still remain unclarified. Most of the skull growth in craniosynostosis is completed in the first year, and the bone is strong enough to undergo distraction osteogenesis. However, previous reports showed that patients operated on before 1 year of age had better IQ than those operated later in life. This report aims to consider the best timing for cranial expansion and surgical strategy for Apert syndrome...
March 24, 2017: Congenital Anomalies
Lisa M Morris
This article provides an overview of etiology, epidemiology, pathology, diagnosis, and treatment of nonsyndromic craniosynostosis, including sagittal, metopic, coronal, lambdoid, and complex synostosis. Detailed discussion is presented regarding indications for surgical intervention and management options, including frontoorbital advancement, cranial vault reconstruction, endoscopic strip craniectomy, spring-assisted strip craniectomy, and cranial vault distraction osteogenesis. Deformational plagiocephaly is also presented with treatment options including repositioning, physical therapy, and helmet therapy...
November 2016: Facial Plastic Surgery Clinics of North America
Jan-Falco Wilbrand, Hans-Peter Howaldt, Marcus Reinges, Petros Christophis
OBJECTIVE: Premature craniosynostosis of the lambdoid suture is rare. The use of differential diagnosis to rule out positional occipital plagiocephaly is crucial. Nevertheless, once diagnosed, lambdoid craniosynostosis requires corrective surgery to prevent intracranial harm and aesthetic stigma by significant dyscrania. Operative correction of the lambdoid fusion is often performed by suturectomy and helmet therapy, total occipital remodeling interventions, transposition of occipital bone flaps, or occipital advancement procedures either with or without distraction osteogenesis...
October 2016: Journal of Cranio-maxillo-facial Surgery
Dana Johns, Erin Anstadt, Daniel Donato, John Kestle, Jay Riva-Cambrin, Faizi Siddiqi, Barbu Gociman
Posterior cranial vault distraction (PCVD) has become an important modality in the management of complex craniosynostosis to increase intracranial volume and improve the cranial vault appearance. This technique can safely be performed as early as 3 months of age for the initial management of patients with complex craniosynostosis. A retrospective review was performed of all the patients with syndromic, multiple-suture synostosis treated with PCVD at Primary Children's Hospital in Salt Lake City, Utah, between 2012 and 2014...
September 2016: Craniomaxillofacial Trauma & Reconstruction
Azusa Shimizu, Yuzo Komuro, Kazuaki Shimoji, Masakazu Miyajima, Hajime Arai
Posterior cranial vault distraction is considered to be more effective for increasing intracranial volume than fronto-orbital advancement or anterior cranial vault expansion, but the changes in intracranial volumes after posterior cranial vault distraction remain unclear. The changes in intracranial volume were investigated in patients of premature craniosynostosis treated by this technique. Seven patients, 3 boys and 4 girls aged from 5 months to 3 years 3 months (mean 23 months) at operation, with craniosynostosis underwent posterior cranial vault distraction at Juntendo University Hospital from 2011 to 2014...
July 2016: Journal of Craniofacial Surgery
Jing Li, Patrick A Gerety, Wen Xu, Scott P Bartlett, Jesse A Taylor
There is a growing literature on the advantages of posterior cranial vault distraction osteogenesis (PVDO) in infants, particularly those with syndromic and multisuture craniosynostosis. This study aims to compare perioperative outcomes of PVDO in older patients to those of infants. A prospective craniofacial database was queried for patients aged 5 and older undergoing PVDO; controls were diagnosis-matched infants. Demographic, perioperative, and distraction data was compared using a 2-sample t test and Fisher exact test...
July 2016: Journal of Craniofacial Surgery
Akira Gomi, Ataru Sunaga, Hideaki Kamochi, Hirofumi Oguma, Yasushi Sugawara
In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention...
May 2016: Journal of Korean Neurosurgical Society
Hiroaki Sakamoto, Yasuhiro Matsusaka, Noritsugu Kunihiro, Keisuke Imai
Syndromic craniosynostosis has severe cranial stenosis and deformity, combined with hypoplastic maxillary bone and other developmental skeletal lesions. Among these various lesions, upper air way obstruction by hypoplastic maxillary bone could be the first life-threatening condition after birth. Aggressive cranial vault expansion for severely deformed cranial vaults due to multiple synostoses is necessary even in infancy, to normalize the intracranial pressure. Fronto-orbital advancement (FOA) is recommended for patients with hypoplastic anterior part of cranium induced by bicoronal and/or metopic synostoses, and posterior cranial vault expansion is recommended for those with flattening of the posterior part of the cranium by lambdoid synostosis...
May 2016: Journal of Korean Neurosurgical Society
Yoshiaki Sakamoto, Tomoru Miwa, Hideo Nakajima, Kazunari Yoshida, Kazuo Kishi
BACKGROUND: Posterior cranial vault distraction osteogenesis is a common treatment for syndromal patients of brachycephaly and oxycephaly. Although posterior distraction can increase intracranial volume, the flattened head phenotype is difficult to correct. The authors examined a new posterior distraction technique termed double-door distraction for improvement of the flattened head phenotype. METHODS: From 2010 to 2013, 6 patients with flattened posterior craniums were operated on using the double-door distraction technique...
June 2016: Journal of Craniofacial Surgery
Gerhard S Mundinger, Shady A Rehim, Owen Johnson, Joy Zhou, Anne Tong, Christopher Wallner, Amir H Dorafshar
BACKGROUND: Distraction osteogenesis has been proposed as an alternative to cranial remodeling surgery for craniosynostosis, but technique descriptions and outcome analyses are limited to small case series. This review summarizes operative characteristics and outcomes of distraction osteogenesis and presents data comparing distraction osteogenesis to cranial remodeling surgery. METHODS: A systematic review of the literature was undertaken. Descriptive analysis, operative technical data, outcomes, or postoperative complications of distraction osteogenesis for craniosynostosis were included...
September 2016: Plastic and Reconstructive Surgery
Jordan W Swanson, Fares Samra, Andrew Bauder, Brianne T Mitchell, Jesse A Taylor, Scott P Bartlett
BACKGROUND: The authors hypothesize that early posterior vault distraction osteogenesis safely confers considerable cranial vault remodeling, sufficient to enable fronto-orbital advancement to be delayed to a later age, with improved outcomes. METHODS: The authors conducted a retrospective cohort study of children with syndromic craniosynostosis treated before (2003 to 2008) or after (2009 to 2014) implementation of posterior vault distraction osteogenesis. RESULTS: Sixty children with syndromic craniosynostosis presented during the study period...
May 2016: Plastic and Reconstructive Surgery
Shannon Wong, Eric S Nagengast, Jason Miller
Normocephalic pancraniosynostosis is a rare form of craniosynostosis that usually presents later in life secondary to a delayed onset of symptoms and the presence of a normal head shape. Since its initial description in the literature in 2010, normocephalic pancraniosynostosis remains a rare clinical entity that has only been reported in 6 patients. Surgical treatment in the 2 published reports has been by staged total calvarial reconstruction or anterior cranial vault remodeling with bilateral frontoorbital advancement...
May 2016: Journal of Craniofacial Surgery
Lisa Morris
Many procedures exist for treatment of craniosynostosis. The goal of all surgical interventions is to correct the skull deformities associated with the synostosis and to prevent the sequela of elevated intracranial pressure. Open cranial vault reconstructions address these issues at the time of surgery, but have the potential for increased blood loss and longer hospital stays. Minimally invasive procedures have shorter operative times and decreased blood loss, but rely on the cranial abnormality to improve over time with helmets or distraction devices...
April 2016: Facial Plastic Surgery: FPS
Federico Di Rocco, Alexandru Szathmari, Carmine Mottolese
BACKGROUND: Posterior cranial vault distraction osteogenesis is currently used to enlarge the cranial volume and control the intracranial pressure. This procedure carries the risk of hardware dislocation, and especially in infants, as their skull being thin, the screws may damage the underlying dura. TECHNICAL NOTE: In this paper, the authors describe a simple method to fixate the internal distractor to the skull vault in case of thin calvaria using metallic wires...
June 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Ahmad N Saad, Melissa Kanack, Joyce McIntyre, Michael Levy, Hal Meltzer, Steven R Cohen
Macrocephaly resulting from untreated hydrocephalus is a rare but difficult condition to treat. The patient presented is a 6-year-old boy who had progressively increasing head size since birth secondary to untreated hydrocephalus with associated developmental delay. His initial head circumference was 69 cm, and computed tomography scan showed evidence of obstructive hydrocephalus. For the first stage of the procedure, bicoronal and circumferential strip craniectomies were performed, 5 fully open 3.5 mm midface distractors were placed to facilitate vault reduction, and absorbable plates were placed in the frontoorbital region...
November 2015: Journal of Craniofacial Surgery
Brianne T Mitchell, Jordan W Swanson, Jesse A Taylor
Multisuture craniosynostosis with a mild cloverleaf deformity is rare but associated with high morbidity and mortality. Conventional treatment to alleviate intracranial hypertension in a young infant involves multisuturectomy and relies on passive correction of the deformity followed by additional staged reconstruction later in infancy. Early regional craniectomy and rigid reconstruction have been described, but the cranial bone has limited stability to tolerate plate fixation and extensive dissection of the bone-dura interface may devascularize the cranial bone flap and limit its durability...
September 2015: Journal of Craniofacial Surgery
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