Posterior cranial distraction in the treatment of craniosynostosis—effects on intracranial volume
- 190 Downloads
Posterior cranial expansion has become increasingly practiced in the treatment of patients with craniosynostosis and a brachyturricephalic dysmorphology. This study aims to assess the gain in intracranial volume obtained by expanding the posterior cranial vault by internal distraction in these patients.
Three consecutive patients, one with Saethre–Chotzen syndrome, one with Apert syndrome, and one with nonsyndromic bicoronal synostosis underwent posterior cranial vault distraction using two pairs of distractors and a previously described accelerated distraction protocol. The procedure was performed at an average age of 5.3 (4.7–6.1) months. Intracranial volumes were calculated with OsiriX© from computer tomographies obtained prior to placement and removal of distractors.
The average gain in total intracranial volume was 21 (14–29) %. The volume of the anterior cranial fossa was increased by an average of 22.3 (4–41) %. However, the volume increase of the anterior cranial cavity had only a minor contribution to the total intracranial volume expansion.
Posterior cranial vault expansion with internal distractors has the potential to efficiently increase the volume of the intracranial cavity. From this small series, it appears that the volume gain is large, albeit variable, and that some remodeling may occur in the anterior cranium.
Level of evidence: Level V, therapeutic study
KeywordsCraniosynostosis Intracranial volume Distraction Brachycephaly
Conflict of interest
- 6.Nowinski D, Saiepour D, Leikola J, Messo E, Nilsson P, Enblad P (2011) Posterior cranial vault expansion performed with rapid distraction and time-reduced consolidation in infants with syndromic craniosynostosis. Childs Nerv Syst 27(11):1999–2003. doi: 10.1007/s00381-011-1563-1 PubMedCrossRefGoogle Scholar
- 7.Serlo WS, Ylikontiola LP, Lahdesluoma N, Lappalainen OP, Korpi J, Verkasalo J, Sandor GK (2011) Posterior cranial vault distraction osteogenesis in craniosynostosis: estimated increases in intracranial volume. Childs Nerv Syst 27(4):627–633. doi: 10.1007/s00381-010-1353-1 PubMedCrossRefGoogle Scholar
- 10.Fateh Ahmad NW, Evans M, Dover S, Solanki G, Nishikawa H, Rodrigues D (2012) The impact of posterior calvarial distraction on Chiari malformations and syringomyelia. Paper presented at the European Society of Craniofacial Surgery Bienial Meeting, GothenburgGoogle Scholar
- 11.Steinbacher DM, Skirpan J, Puchala J, Bartlett SP (2011) Expansion of the posterior cranial vault using distraction osteogenesis. Plast Reconstr Surg 127(2):792–801. doi: 10.1097/PRS.0b013e318200ab8300006534-201102000-00037 PubMedCrossRefGoogle Scholar