Morphometric analysis and outcomes following posterior cranial vault distraction in syndromic and multisuture craniosynostosis

Sultan Al-Shaqsi; Jessica A Ching; Christine B Novak; Christopher R Forrest

doi:10.1016/j.bjps.2023.10.101

Morphometric analysis and outcomes following posterior cranial vault distraction in syndromic and multisuture craniosynostosis

J Plast Reconstr Aesthet Surg. 2023 Dec:87:379-386. doi: 10.1016/j.bjps.2023.10.101. Epub 2023 Oct 20.

Authors

Sultan Al-Shaqsi¹, Jessica A Ching², Christine B Novak¹, Christopher R Forrest³

Affiliations

¹ Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada.
² Division of Plastic Surgery, University of Florida, Gainesville, Florida, USA.
³ Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada. Electronic address: christopher.forrest@sickkids.ca.

PMID: 37935093
DOI: 10.1016/j.bjps.2023.10.101

Abstract

Background: Turribrachycephaly is a common feature in many syndromic and multisuture craniosynostoses and is traditionally treated with total cranial vault reshaping and fronto-orbital advancement. A staged approach with posterior cranial vault distraction as a primary procedure followed by anterior cranial vault reshaping has the advantage of reducing the vertical dimension of the skull in a controlled and gradual manner while expanding the cranial volume. The purpose of this study was to evaluate outcomes following posterior cranial vault expansion using distraction osteogenesis at a single tertiary pediatric center.

Methods: This retrospective review included all cases of posterior cranial vault distraction at a single institution from 2008 to 2022 performed by one surgeon. Morphometric outcomes such as Turricephaly Index (TI) and posterior cranial volume (PCV) were assessed from pre- and postoperative computerized tomography scans for patients who underwent posterior cranial vault distraction as a primary first-stage operation. Clinical outcomes and complications were collated.

Results: A total of 41 patients (25 females, 16 males; mean age 11 months) with syndromic craniosynostosis (n = 32) and nonsyndromic craniosynostosis (n = 9) were included. The main indication for posterior cranial vault distraction in this cohort was turricephaly (63%). The mean distraction distance was 25.9 mm and the mean decrease in TI was 18%. The estimated increase in PCV from distraction in this cohort was 19.7%. In this cohort of patients, 13 patients (32%) experienced complications but there were no mortalities.

Conclusion: Posterior cranial vault distraction osteogenesis is an effective surgical procedure to increase intracranial volume and correct turricephaly in children with syndromic and nonsyndromic craniosynostosis. This procedure is considered a safe and effective first-stage cranial operation in children with syndromic craniosynostosis with increased intracranial pressure and or turricephaly.

Keywords: Craniosynostosis; ICP; Multisuture surgery; Posterior cranial vault distraction; Syndromic; Turribrachycephaly.

MeSH terms

Child
Craniosynostoses* / diagnostic imaging
Craniosynostoses* / surgery
Female
Head
Humans
Infant
Male
Osteogenesis, Distraction* / methods
Retrospective Studies
Skull / surgery
Tomography, X-Ray Computed