Advertisement

Child's Nervous System

, Volume 29, Issue 5, pp 815–820 | Cite as

Spring-assisted posterior vault expansion in multisuture craniosynostosis

  • T. de JongEmail author
  • M. L. C. van Veelen
  • I. M. J. Mathijssen
Original Paper

Abstract

Purpose

Patients with Apert and Crouzon syndromes and craniofrontonasal dysplasia need a vault expansion within the first year of life to treat or prevent the development of raised intracranial pressure. Many craniofacial units perform a conventional posterior vault expansion as initial surgery; an alternative to this technique is the spring-assisted posterior vault expansion. The purpose of this study was to demonstrate the efficacy of spring-assisted posterior vault expansion and to compare this technique with the conventional method.

Methods

A retrospective study was conducted among all consecutive patients who received a posterior vault expansion between 2006 and 2011. Patients treated with springs were compared with patients treated with the conventional technique for blood loss, duration of surgery, postoperative hospital admittance, increase in skull circumference and anterior-posterior length, and complications.

Results

Of the 31 included patients, 15 were treated with springs, and 16, with the conventional technique. Patients treated with springs had a significantly larger increase in skull circumference and anterior-posterior length, and not significant changes in blood loss compared with the conventional group. Complications in the conventional group were the following: minor dural tear in three patients, problematic wound healing in one patient, and insufficient expansion in one patient. Spring-related complications included skin perforation in two patients, a minor dural tear in two patients, and leakage of cerebrospinal fluid after an unnoticed dural tear during spring placement in one patient.

Conclusion

Spring-assisted posterior vault expansion has some advantages over the conventional technique and is, therefore, the preferred technique in our center.

Keywords

Craniosynostosis Posterior vault expansion Springs 

Notes

Acknowledgments

This study was funded by the Nuts Ohra foundation and Stichting Hoofdzaken.

References

  1. 1.
    Anderson PJ, Harkness WJ, Taylor W, Jones BM, Hayward RD (1997) Anomalous venous drainage in a case of non-syndromic craniosynostosis. Childs Nerv Syst 13(2):97–100PubMedCrossRefGoogle Scholar
  2. 2.
    Arnaud E, Marchac A, Jeblaoui Y, Renier D, Di Rocco F (2012) Spring-assisted posterior skull expansion without osteotomies. Childs Nerv Syst 28(9):1545–1549PubMedCrossRefGoogle Scholar
  3. 3.
    Davis C, Lauritzen CG (2009) Frontobasal suture distraction corrects hypotelorism in metopic synostosis. J Craniofac Surg 20(1):121–124PubMedCrossRefGoogle Scholar
  4. 4.
    Davis C, MacFarlane MR, Wickremesekera A (2010) Occipital expansion without osteotomies in Apert syndrome. Childs Nerv Syst 26(11):1543–1548PubMedCrossRefGoogle Scholar
  5. 5.
    de Jong T, Bannink N, Bredero-Boelhouwer HH, van Veelen ML, Bartels MC, Hoeve LJ, Hoogeboom AJ, Wolvius EB, Lequin MH, van der Meulen JJ, van Adrichem LN, Vaandrager JM, Ongkosuwito EM, Joosten KF, Mathijssen IM (2010) Long-term functional outcome in 167 patients with syndromic craniosynostosis; defining a syndrome-specific risk profile. J Plast Reconstr Aesthet Surg 63(10):1635–1641PubMedCrossRefGoogle Scholar
  6. 6.
    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):137–140PubMedCrossRefGoogle Scholar
  7. 7.
    Lauritzen C, Sugawara Y, Kocabalkan O, Olsson R (1998) Spring mediated dynamic craniofacial reshaping. Case report. Scand J Plast Reconstr Surg Hand Surg 32(3):331–338PubMedCrossRefGoogle Scholar
  8. 8.
    Lauritzen CG, Davis C, Ivarsson A, Sanger C, Hewitt TD (2008) The evolving role of springs in craniofacial surgery: the first 100 clinical cases. Plast Reconstr Surg 121(2):545–554PubMedGoogle Scholar
  9. 9.
    Lee JA, Park DH, Yoon SH, Chung J (2008) Distractor breakage in cranial distraction osteogenesis for children with craniosynostosis. Pediatr Neurosurg 44(3):216–220PubMedCrossRefGoogle Scholar
  10. 10.
    Marucci DD, Dunaway DJ, Jones BM, Hayward RD (2008) Raised intracranial pressure in Apert syndrome. Plast Reconstr Surg 122(4):1162–1168, discussion 1169-1170PubMedCrossRefGoogle Scholar
  11. 11.
    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):1537–1544PubMedCrossRefGoogle Scholar
  12. 12.
    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):1999–2003PubMedCrossRefGoogle Scholar
  13. 13.
    Pyle J, Glazier S, Couture D, Sanger C, Gordon S, David L (2009) Spring-assisted surgery-a surgeon’s manual for the manufacture and utilization of springs in craniofacial surgery. J Craniofac Surg 20(6):1962–1968PubMedCrossRefGoogle Scholar
  14. 14.
    Riley AA, Arakawa Y, Worley S, Duncan BW, Fukamachi K (2010) Circulating blood volumes: a review of measurement techniques and a meta-analysis in children. ASAIO J 56(3):260–264PubMedCrossRefGoogle Scholar
  15. 15.
    Rutland P, Pulleyn LJ, Reardon W, Baraitser M, Hayward R, Jones B, Malcolm S, Winter RM, Oldridge M, Slaney SF et al (1995) Identical mutations in the FGFR2 gene cause both Pfeiffer and Crouzon syndrome phenotypes. Nat Genet 9(2):173–176PubMedCrossRefGoogle Scholar
  16. 16.
    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):627–633PubMedCrossRefGoogle Scholar
  17. 17.
    Sgouros S, Goldin JH, Hockley AD, Wake MJ (1996) Posterior skull surgery in craniosynostosis. Childs Nerv Syst 12(11):727–733PubMedCrossRefGoogle Scholar
  18. 18.
    Steinbacher DM, Skirpan J, Puchala J, Bartlett SP (2011) Expansion of the posterior cranial vault using distraction osteogenesis. Plast Reconstr Surg 127(2):792–801PubMedCrossRefGoogle Scholar
  19. 19.
    Swennen G, Schliephake H, Dempf R, Schierle H, Malevez C (2001) Craniofacial distraction osteogenesis: a review of the literature: part 1: clinical studies. Int J Oral Maxillofac Surg 30(2):89–103PubMedCrossRefGoogle Scholar
  20. 20.
    Thompson DN, Hayward RD, Harkness WJ, Bingham RM, Jones BM (1995) Lessons from a case of kleeblattschadel. Case report. J Neurosurg 82(6):1071–1074PubMedCrossRefGoogle Scholar
  21. 21.
    Tuncbilek G, Kaykcoglu A, Bozkurt G, Akalan N (2012) Spring-mediated cranioplasty in patients with multiple-suture synostosis and cloverleaf skull deformity. J Craniofac Surg 23(2):374–377PubMedCrossRefGoogle Scholar
  22. 22.
    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):231–236PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • T. de Jong
    • 1
    Email author
  • M. L. C. van Veelen
    • 2
  • I. M. J. Mathijssen
    • 1
  1. 1.Department of Plastic, Reconstructive and Hand SurgeryErasmus MCRotterdamThe Netherlands
  2. 2.Department of NeurosurgeryErasmus MCRotterdamThe Netherlands

Personalised recommendations