Skip to main content
SpringerLink
Log in

Results of posterior cranial vault remodeling for plagiocephaly and brachycephaly by the meander technique

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Objective

Several techniques to remodel the posterior calvarium in order to increase intracranial volume (ICV) and to improve cosmetic appearance are reported. This study presents the results of meander technique in patients with brachycephaly and posterior plagiocephaly.

Methods

During December 2011 and July 2013, a total of 12 children (median age: 15 months) underwent posterior cranial vault remodeling by the meander technique (brachycephaly, n = 6; posterior plagiocephaly, n = 6). The available pre- and postoperative MRIs were assessed with regard to ICV, cranial index (CI) and asymmetry index (AI) as well as the position of the cerebellar tonsils.

Results

No intra- or postoperative complications were observed. Blood transfusions were necessary in nine of 12 patients. A significant increase of the ICV from 1,178.4 ± 134.5 to 1,293.0 ± 137.5 cm3 (p < 0.05) is demonstrated. In the patients with brachycephaly the CI was significantly improved from 0.97 ± 0.12 to 0.89 ± 0.12 postoperatively (p < 0.05). The AI in patients with posterior plagiocephaly was significantly ameliorated from 0.83 ± 0.04 to 0.92 ± 0.02 postoperatively (p < 0.05). There was a significant effect on cerebellar tonsil position in relation to foramen magnum level for patients with brachycephaly (right tonsil: 11.9 ± 9.2 to 7.0 ± 9.1 mm, p < 0.05; left: 10.8 ± 9.5 to 9.7 ± 10.6 mm; p < 0.05) as well as in posterior plagiocephaly for the ipsilateral tonsil (3.2 ± 3.5 to 1.6 ± 3.5 mm; p < 0.01).

Conclusion

The presented surgical technique is considered to be safe. The technique is capable to significantly increase ICV and improve cosmetic appearance of the remodeled calvarium. Further evidence that posterior cranial vault remodeling influences the position of the cerebellar tonsils is added by the results of the study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abbott AH, Netherway DJ, Niemann DB, Clark B, Yamamoto M, Cole J, Hanieh A, Moore MH, David DJ (2000) CT-determined intracranial volume for a normal population. J Craniofacial Surg 11(3):211–223

    Article  CAS  Google Scholar 

  2. Argenta LC, David LR, Wilson JA, Bell WO (1996) An increase in infant cranial deformity with supine sleeping position. J Craniofacial Surg 7(1):5–11

    Article  CAS  Google Scholar 

  3. Arnaud E, Marchac A, Jeblaoui Y, Renier D, Di Rocco F (2012) Spring-assisted posterior skull expansion without osteotomies. Childs Nerv Syst 28(9):1545–1549. doi:10.1007/s00381-012-1843-4

    Article  PubMed  Google Scholar 

  4. Brain Development Cooperative G (2012) Total and regional brain volumes in a population-based normative sample from 4 to 18 years: the NIH MRI Study of Normal Brain Development. Cereb Cortex 22(1):1–12. doi:10.1093/cercor/bhr018

    Article  Google Scholar 

  5. Choi M, Flores RL, Havlik RJ (2012) Volumetric analysis of anterior versus posterior cranial vault expansion in patients with syndromic craniosynostosis. J Craniofacial Surg 23(2):455–458. doi:10.1097/SCS.0b013e318240ff49

    Article  Google Scholar 

  6. Cinalli G, Chumas P, Arnaud E, Sainte-Rose C, Renier D (1998) Occipital remodeling and suboccipital decompression in severe craniosynostosis associated with tonsillar herniation. Neurosurgery 42(1):66–71, discussion 71–63

    Article  CAS  PubMed  Google Scholar 

  7. Cinalli G, Spennato P, Sainte-Rose C, Arnaud E, Aliberti F, Brunelle F, Cianciulli E, Renier D (2005) Chiari malformation in craniosynostosis. Childs Nerv Syst 21(10):889–901. doi:10.1007/s00381-004-1115-z

    Article  PubMed  Google Scholar 

  8. Davis C, MacFarlane MR, Wickremesekera A (2010) Occipital expansion without osteotomies in Apert syndrome. Childs Nerv Syst 26(11):1543–1548. doi:10.1007/s00381-010-1144-8

    Article  PubMed  Google Scholar 

  9. de Jong T, Rijken BF, Lequin MH, van Veelen ML, Mathijssen IM (2012) Brain and ventricular volume in patients with syndromic and complex craniosynostosis. Childs Nerv Syst 28(1):137–140. doi:10.1007/s00381-011-1614-7

    Article  PubMed Central  PubMed  Google Scholar 

  10. Dekaban AS (1977) Tables of cranial and orbital measurements, cranial volume, and derived indexes in males and females from 7 days to 20 years of age. Ann Neurol 2(6):485–491. doi:10.1002/ana.410020607

    Article  CAS  PubMed  Google Scholar 

  11. Deschamps-Braly J, Hettinger P, el Amm C, Denny AD (2011) Volumetric analysis of cranial vault distraction for cephalocranial disproportion. Pediatr Neurosurg 47(6):396–405. doi:10.1159/000337873

    Article  PubMed  Google Scholar 

  12. Di Rocco F, Marchac A, Duracher C, Perie AC, Vergnaud E, Renier D, Arnaud E (2012) Posterior remodeling flap for posterior plagiocephaly. Childs Nerv Syst 28(9):1395–1397. doi:10.1007/s00381-012-1842-5

    Article  PubMed  Google Scholar 

  13. Engel M, Castrillon-Oberndorfer G, Hoffmann J, Orakcioglu B, Rohde S, Seeberger R, Freudlsperger C (2012) Chiari malformation in nonsyndromal single craniosynostosis—much ado about nothing? Acta Neurochirurg 154(10):1803–1807. doi:10.1007/s00701-012-1439-5

    Article  CAS  Google Scholar 

  14. Goldstein JA, Paliga JT, Wink JD, Low DW, Bartlett SP, Taylor JA (2013) A craniometric analysis of posterior cranial vault distraction osteogenesis. Plastic Reconstr Surg 131(6):1367–1375. doi:10.1097/PRS.0b013e31828bd541

    Article  CAS  Google Scholar 

  15. Goodrich JT, Tepper O, Staffenberg DA (2012) Craniosynostosis: posterior two-third cranial vault reconstruction using bioresorbable plates and a PDS suture lattice in sagittal and lambdoid synostosis. Childs Nerv Syst 28(9):1399–1406. doi:10.1007/s00381-012-1767-z

    Article  PubMed  Google Scholar 

  16. Graham JM Jr, Gomez M, Halberg A, Earl DL, Kreutzman JT, Cui J, Guo X (2005) Management of deformational plagiocephaly: repositioning versus orthotic therapy. J Pediatr 146(2):258–262. doi:10.1016/j.jpeds.2004.10.016

    Article  PubMed  Google Scholar 

  17. Karppinen A, Koljonen V, Valanne L, Leikola J (2012) Asymmetric laterality of Chiari type I malformation in patients with non-syndromic single-suture craniosynostosis. Acta Neurochirurg 154(11):2103–2107. doi:10.1007/s00701-012-1470-6

    Article  CAS  Google Scholar 

  18. Leikola J, Hukki A, Karppinen A, Valanne L, Koljonen V (2012) The evolution of cerebellar tonsillar herniation after cranial vault remodeling surgery. Childs Nerv Syst 28(10):1767–1771. doi:10.1007/s00381-012-1816-7

    Article  CAS  PubMed  Google Scholar 

  19. Levitt MR, Niazi TN, Hopper RA, Ellenbogen RG, Ojemann JG (2012) Resolution of syndromic craniosynostosis-associated Chiari malformation Type I without suboccipital decompression after posterior cranial vault release. J Neurosurg Pediatr 9(2):111–115. doi:10.3171/2011.11.PEDS11268

    Article  PubMed  Google Scholar 

  20. Lichtenberg R (1960) Radiographie du crane de 226 enfants normaux de la naissance a 8 ans: Impressions digitiformes, capacite, angles et indices. Doctoral En Medecine thesis, University of Paris

  21. Lipira AB, Gordon S, Darvann TA, Hermann NV, Van Pelt AE, Naidoo SD, Govier D, Kane AA (2010) Helmet versus active repositioning for plagiocephaly: a three-dimensional analysis. Pediatrics 126(4):e936–945. doi:10.1542/peds.2009-1249

    Article  PubMed  Google Scholar 

  22. Netherway DJ, Abbott AH, Anderson PJ, David DJ (2005) Intracranial volume in patients with nonsyndromal craniosynostosis. J Neurosurg 103(2 Suppl):137–141. doi:10.3171/ped.2005.103.2.0137

    PubMed  Google Scholar 

  23. Nowinski D, Di Rocco F, Renier D, SainteRose C, Leikola J, Arnaud E (2012) Posterior cranial vault expansion in the treatment of craniosynostosis. Comparison of current techniques. Childs Nerv Syst 28(9):1537–1544. doi:10.1007/s00381-012-1809-6

    Article  PubMed  Google Scholar 

  24. Posnick JC, Armstrong D, Bite U (1995) Crouzon and Apert syndromes: intracranial volume measurements before and after cranio-orbital reshaping in childhood. Plastic Reconstr Surg 96(3):539–548

    Article  CAS  Google Scholar 

  25. Posnick JC, Armstrong D, Bite U (1995) Metopic and sagittal synostosis: intracranial volume measurements prior to and after cranio-orbital reshaping in childhood. Plastic Reconstr Surg 96(2):299–309, discussion 310–295

    Article  CAS  Google Scholar 

  26. Scott WW, Fearon JA, Swift DM, Sacco DJ (2013) Suboccipital decompression during posterior cranial vault remodeling for selected cases of Chiari malformations associated with craniosynostosis. J Neurosurg Pediatr 12(2):166–170. doi:10.3171/2013.4.PEDS12463

    Article  PubMed  Google Scholar 

  27. Sgouros S, Hockley AD, Goldin JH, Wake MJ, Natarajan K (1999) Intracranial volume change in craniosynostosis. J Neurosurg 91(4):617–625. doi:10.3171/jns.1999.91.4.0617

    Article  CAS  PubMed  Google Scholar 

  28. Steinbacher DM, Skirpan J, Puchala J, Bartlett SP (2011) Expansion of the posterior cranial vault using distraction osteogenesis. Plastic Reconstr Surg 127(2):792–801. doi:10.1097/PRS.0b013e318200ab83

    Article  CAS  Google Scholar 

  29. Tuncbilek G, Alanay Y, Uzun H, Kayikcioglu A, Akarsu NA, Benli K (2010) Intracranial and extracranial malformations in patients with craniofacial anomalies. J Craniofacial Surg 21(5):1460–1464. doi:10.1097/SCS.0b013e3181ebcd27

    Article  Google Scholar 

  30. Turk AE, McCarthy JG, Thorne CH, Wisoff JH (1996) The “back to sleep campaign” and deformational plagiocephaly: is there cause for concern? J Craniofacial Surg 7(1):12–18

    Article  CAS  Google Scholar 

  31. Wagner W, Schwandt E, Huthmann A, Vulcu S, Tschan C (2010) Posterior calvarial augmentation in premature craniosynostosis: a technique avoiding foreign implants or free bone flaps. Childs Nerv Syst 26(11):1549–1553. doi:10.1007/s00381-010-1158-2

    Article  PubMed  Google Scholar 

  32. White N, Evans M, Dover MS, Noons P, Solanki G, Nishikawa H (2009) Posterior calvarial vault expansion using distraction osteogenesis. Childs Nerv Syst 25(2):231–236. doi:10.1007/s00381-008-0758-6

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Arbeitsbereich Pädiatrische Neurochirurgie, Charité Universitätsmedizin, Berlin, Germany

    Matthias Schulz, Hannes Haberl & Ulrich-Wilhelm Thomale

  2. Institut für Radiologie, Charité Universtätsmedizin, Berlin, Germany

    Birgit Spors

  3. Arbeitsbereich Pädiatrische Neurochirurgie, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Ulrich-Wilhelm Thomale

Authors
  1. Matthias Schulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Birgit Spors
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hannes Haberl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulrich-Wilhelm Thomale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ulrich-Wilhelm Thomale.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schulz, M., Spors, B., Haberl, H. et al. Results of posterior cranial vault remodeling for plagiocephaly and brachycephaly by the meander technique. Childs Nerv Syst 30, 1517–1526 (2014). https://doi.org/10.1007/s00381-014-2462-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-014-2462-z

Keywords

Search

Navigation