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Posterior cranial vault distraction in children with syndromic craniosynostosis: the era of biodegradable materials—a comprehensive review of the literature and proposed novel global application

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Abstract

Distraction osteogenesis is utilized to increase intracranial volume in the treatment of restrictive pathologies, most commonly syndromic synostosis. Children too young for open calvarial vault expansion or other systemic or local contraindications to a direct reconstructive approach benefit greatly from distraction osteogenesis, typically addressing posterior vault expansion. Wound infection, cerebrospinal fluid (CSF) leak, device failure, need for a second surgery for removal, and cost, are issues that can limit the use of this approach. These challenges are more pronounced in low- and middle-income countries (LMICs) due to lack of access to the device, the financial burden of the need for a second surgery, and the severity of the implications of infection and CSF leak. Over the last five decades, there has been an increased acceptance of bioresorbable instrumentation in craniofacial surgery. Poly L-lactic acid, polyglycolic acid, and polydioxanone are the most commonly used polymers. New resorbable fixation tools such as ultrasound-activated pins and heat-activated pins are superior to conventional bioresorbable screws in allowing attachment to thinner bone plates. In this paper, we present a review of the literature on cranial vault distraction and the use of bioresorbable materials and propose a novel design of a fully absorbable cranial distractor system using external magnetic distraction control, eliminating the need for external activation ports and a second surgery to remove the hardware. The application of this technology in LMIC settings could advance access to care and treatment options for patients with syndromic synostosis.

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Author information

Author notes

  1. Caitlin Hoffman and Susan C. Pannullo are senior co-authors.

Authors and Affiliations

  1. Department of Neurological Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 99, New York, NY, USA

    Mohammed A. Fouda, Kyle Zappi, Caitlin Hoffman & Susan C. Pannullo

  2. School of Medicine, Tulane University, New Orleans, LA, USA

    Laurel A. Seltzer

  3. Department of Biomedical Engineering, Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA

    Susan C. Pannullo

Authors
  1. Mohammed A. Fouda
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  2. Laurel A. Seltzer
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MAF, LS, and KZ wrote the initial manuscript. MAF prepared the tables and figures. All authors reviewed the final manuscript.

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Correspondence to Mohammed A. Fouda.

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Fouda, M.A., Seltzer, L.A., Zappi, K. et al. Posterior cranial vault distraction in children with syndromic craniosynostosis: the era of biodegradable materials—a comprehensive review of the literature and proposed novel global application. Childs Nerv Syst 40, 759–768 (2024). https://doi.org/10.1007/s00381-023-06221-7

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