Increases in Cranial Volume with Posterior Cranial Vault Distraction in 31 Consecutive Cases

Neurosurgery. 2017 Nov 1;81(5):803-811. doi: 10.1093/neuros/nyx125.

Abstract

Background: Posterior cranial vault distraction (PCVD) is a technique widely used in surgical treatment of craniosynostosis when cranial expansion is required. It has proven to be safe and to allow a significant increase of intracranial volume.

Objective: To evaluate increases in intracranial volume as a result of PCVD performed in Oulu Craniofacial center using 2 different methods based on 3-dimensional (3-D) photogrammetric imaging or plain skull radiographs.

Methods: All children less than 16 yr of age who were treated by PCVD (n = 31) from 2009 to 2015 at the Oulu Craniofacial Center were included. All patients were followed at outpatient clinics with plain radiographs performed for follow-up. In 5 patients, additional 3-D photogrammetric imaging was done pre- and postoperatively.

Results: The mean intracranial volume increase was 25.0%, ranging from 16.9% to 39.4%. In 5 patients, the increase in volume was calculated from the photogrammetric 3-D images comprising a mean of 17.4%. Volume calculations from cephalograms in the same patients gave a mean of 20.8%. Whether the distraction was a primary operation or patient had undergone previous cranioplasty did not influence the achieved volumetric results. There were no statistically significant differences in the distraction results between different diagnostic groups.

Conclusion: PCVD is an effective surgical method to increase intracranial volume in a variety of clinical entities. Volumetric results of this procedure could be easily evaluated using 3-D photogrammetric imaging or plane radiographs that expose the patients to only low ionizing radiation doses.

Keywords: Cephalometry; Craniofacial abnormalities; Craniosynostoses; Distraction; Photogrammetry.

MeSH terms

  • Child
  • Child, Preschool
  • Craniosynostoses / surgery*
  • Female
  • Humans
  • Imaging, Three-Dimensional / methods
  • Infant
  • Male
  • Osteogenesis, Distraction / adverse effects
  • Osteogenesis, Distraction / methods*
  • Photogrammetry / methods*
  • Prospective Studies
  • Skull / diagnostic imaging*
  • Skull / surgery