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Cranial vault distraction

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
Youssef Tahiri, Jordan W Swanson, Jesse A Taylor
Fronto-orbital advancement and remodeling (FOAR) remains the most widely practiced treatment of unicoronal craniosynostosis (UCS) despite recent studies of ocular dysfunction and aesthetic shortcomings in the long-term. The aim of the study was to compare perioperative morbidity and short-term outcomes of a recently developed, nondevascularizing, distraction-based treatment of UCS with conventional FOAR. To do so, the authors compared the first 6 patients who were treated with a new osteotomy/distraction approach to the last 6 patients who underwent traditional FOAR for the treatment of UCS with regards to demographics, operative details, perioperative morbidity, and short-term outcomes...
September 2015: Journal of Craniofacial Surgery
Dana Johns, Ross Blagg, John R W Kestle, Jay K Riva-Cambrin, Faizi Siddiqi, Barbu Gociman
BACKGROUND: Historically, surgical treatment of children with a delayed presentation of cranial synostosis required complex cranial vault reconstruction. Recently, less invasive options for surgical correction, such as internal distraction osteogenesis, have been explored. In this study, we describe the successful management of delayed presentation of sagittal synostosis using distraction osteogenesis. METHODS: A bicoronal incision was made and 2 large rectangular osteotomies were performed bilaterally, involving the frontal, parietal, temporal and occipital bones...
July 2015: Plastic and Reconstructive Surgery. Global Open
Myung Chul Lee, Kyu Won Shim, Eun Kyung Park, In Sik Yun, Dong Seok Kim, Yong Oock Kim
PURPOSE: Distraction osteogenesis (DO) is a less daunting procedure than extensive cranial vault remodeling and has been used to correct sagittal craniosynostosis. The purposes of this study are to describe DO in combination with expansion and compression procedures and to report analytic results based on the cranial index (CI), volumetric measurement, and neurodevelopmental tests. METHODS: Between June 2002 and May 2013, 32 patients with non-syndromic sagittal synostosis who had undergone antero-posterior compression with bitemporal expansion were recruited...
November 2015: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Yuzo Komuro, Azusa Shimizu, Kazuaki Shimoji, Masakazu Miyajima, Hajime Arai
Twenty years have passed since distraction osteogenesis was introduced into the field of craniomaxillofacial surgery, with distraction osteogenesis gradually consolidating its position for midface advancement in syndromic craniosynostosis. On the other hand, no consensus has been reached regarding its adaptation to calvarial bone. We reported that distraction osteogenesis was useful in posterior cranial vault expansion, and subsequently, similar reports have been successively observed worldwide. In posterior cranial vault distraction, intracranial capacity could be greatly expanded due to its simultaneous expansion with the scalp, with little risk of relapse because new bone is regenerated in the distraction gap...
2015: Neurologia Medico-chirurgica
Youssef Tahiri, Nicholas Bastidas, Donna M McDonald-McGinn, Craig Birgfeld, Elaine H Zackai, Jesse Taylor, Scott P Bartlett
The authors present a new and unique pattern of sutural fusion "peace sign synostosis" (PSS) characterized by synostosis of the metopic, bicoronal, and sagittal sutures and associated with abnormalities of the TWIST1 gene known to be associated with Saethre-Chotzen syndrome (SCS). To do so, we performed a retrospective review of patients with bicoronal, metopic, and at least partial anterior sagittal synostoses at the Children's Hospital of Philadelphia and Seattle Children's Hospital. Patients' demographics, genetic analysis, perioperative and clinic notes were reviewed...
July 2015: Journal of Craniofacial Surgery
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