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Posterior cranial vault distraction osteogenesis in the immunocompromised patient

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Abstract

Purpose

The treatment of patients with multisuture craniosynostosis is complex and patient-dependent. Cranial distraction osteogenesis is a relatively new procedure for treatment of these patients, with its use increasing in many centers. With this increased use comes an expanding range of indications. Surgical management of multisuture craniosynostosis in therapeutically immunosuppressed patients following a solid organ transplant presents unique challenges. We describe our experience with posterior cranial vault distraction in two patients with multisuture craniosynostosis that had previously undergone organ transplantation.

Methods

Two solid-organ transplant recipient patients with multisuture craniosynostosis were identified. A detailed examination of their medical/transplant history and perioperative details were recorded.

Results

The first patient was a 3-year-old girl who received a kidney transplantation in infancy and subsequently presented with a symptomatic Chiari malformation and papilledema. Imaging revealed pansynostosis. She underwent posterior cranial vault distraction extending into a Chiari decompression. Her postoperative course was complicated by distractor site infection at the beginning of consolidation, necessitating early removal of distractors. The second patient was a 2-year-old boy who received a heart transplantation at the age of 3 months and subsequently presented with head shape concerns. Imaging revealed bicoronal and sagittal craniosynostosis. He underwent a posterior cranial vault distraction without complication. Following removal of the distractors, he developed an infection at one of the distractor sites with associated fever and leukocytosis, necessitating washout and drain placement. Both patients achieved successful cranial vault expansion with distraction osteogenesis and at a 2-year follow-up do not have evidence of elevated intracranial pressure.

Conclusions

Immunosuppressive therapy has the potential to inhibit wound healing and place patients at risk for wound infection. Although we have demonstrated successful cranial vault expansion with distraction in two immunosuppressed children, extra care must be taken with these patients when placing semi-buried hardware. Specifically, prompt identification and proactive management of potential infectious complications is critical to applying this technique safely in these patients.

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Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, Children’s of Mississippi, University of Mississippi Medical Center, 2500 State Street, Jackson, MS, 39216, USA

    John S. Sullivan, Laura S. Humphries & Ian C. Hoppe

  2. Department of Surgery, Lake Health Hospital Systems, Mentor, OH, USA

    Alicia E. Snider

  3. University of Mississippi Medical School, Jackson, MS, USA

    Jeffrey Farrington

  4. Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS, USA

    J. Mason Shiflett & Kristin J. Weaver

Authors
  1. John S. Sullivan
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  2. Alicia E. Snider
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  3. Jeffrey Farrington
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  4. J. Mason Shiflett
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  5. Kristin J. Weaver
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  6. Laura S. Humphries
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  7. Ian C. Hoppe
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Contributions

All authors contributed to the design, data collection, and manuscript preparation.

Corresponding author

Correspondence to Ian C. Hoppe.

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Deemed “exempt” from the Institutional Review Board of the University of Mississippi Medical Center.

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Not applicable; the study was retrospective.

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All patients provided written consent for use of pictures in publications.

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No authors report any conflicts of interest.

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Sullivan, J.S., Snider, A.E., Farrington, J. et al. Posterior cranial vault distraction osteogenesis in the immunocompromised patient. Childs Nerv Syst 37, 2313–2318 (2021). https://doi.org/10.1007/s00381-021-05202-y

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  • DOI: https://doi.org/10.1007/s00381-021-05202-y

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