Distraction vs remodeling surgery for craniosynostosis.
ABSTRACT We designed several distraction devices and applied these instruments in 14 patients with varying types of craniosynostosis. The aim of this report is to clarify the advantages and disadvantages of these surgical methods and to discuss current concepts for the surgical strategy in the treatment of craniosynostosis.
From January 2000 to July 2005, 28 patients with craniosynostosis were retrospectively analyzed. Surgical treatment was performed on 14 patients using the distraction method with internal distraction devices that we designed, in which 5 patients had plagiocephaly, 3 brachycephaly, and 6 scaphocephaly. All patients underwent preoperative and postoperative evaluations, which included the patient's neurological state, and three-dimensional CT.
With distraction devices, the time required for the surgery could be shortened almost 3 1/3 h; the bleeding during the surgery was decreased with reduced requirement of more than 200 ml of blood transfusion as compared with remodeling surgery. Postoperatively achieved distraction distances varied from 30.0 to 47.5 mm (mean, 42.99 mm). The average increased volume percent of cranium in distraction surgery group was 20.9% (range, -11.5 to 58.9%) after full distraction.
With distraction surgery, satisfactory cranial volume expansion and aesthetically pleasing morphological states were achieved in all cases, and the efficacy was statistically significantly high as compared with remodeling method.
- Child s Nervous System 10/2007; 23(9):929-36. DOI:10.1007/s00381-007-0400-z · 1.16 Impact Factor
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ABSTRACT: Current multislice computed tomography (CT) technology can be used for diagnosis and surgical planning applying computer-assisted three-dimensional (3D) visualization and surgical simulation. The usefulness of a technique for surgical simulation of frontoorbital advancement is demonstrated here in a child with metopic synostosis. Postprocessing of multi-slice CT data was performed using the software 3D slicer. 3D models were created for the purpose of surgical simulation. These allow planning the course of the osteotomies and individually placing the different bony fragments by an assigned matrix to simulate the surgical result. Photo documentation was obtained before and after surgery. Surgical simulation of the procedure allowed determination of the osteotomy course and assessment of the positioning of the individual bony fragments. Computer-assisted postprocessing and simulation is a useful tool for surgical planning in craniosynostosis surgery. The time-effort for segmentation currently limits the routine clinical use of this technique.Child s Nervous System 12/2007; 23(11):1313-7. DOI:10.1007/s00381-007-0455-x · 1.16 Impact Factor
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ABSTRACT: Cephalocranial disproportion describes a state of volume mismatch between brain size and intracranial space. Nonsyndromic single-suture craniosynostosis patients can present with symptoms from elevated intracranial pressure because of inadequate or delayed treatment. The purpose of this study was to present five sagittal synostosis children with symptomatic cephalocranial disproportion treated with cranial vault distraction osteogenesis. Asymmetric transverse internal distraction osteogenesis was performed to preferentially expand the posterior cranium. A wider base plate, pivot screw, anterior hinge plate, and flexible drive rod were applied to minimize device failure while accomplishing lateral rotation of parietal bones. A distraction protocol was developed and produced consistent results. Two girls and three boys underwent distraction for sagittal synostosis between 2002 and 2006. Average age at surgery was 5.8 years. All had resolution or amelioration of preoperative symptoms. Average operating room time for distractor placement was 2.5 hours (152 minutes) and average hospital stay was 2.8 days. The average distracted distance was 14.4 mm. Average operating room time for distractor removal was 1.1 hours (69 minutes) and average hospital stay was 1.6 days. No perioperative complications occurred. Average follow-up period was 4.2 years, with no recurrence of symptoms. Symptomatic cephalocranial disproportion can present in older children with craniosynostosis. Asymmetric transverse distraction of the posterior cranial vault is a safe and effective treatment modality for this population.Plastic and Reconstructive Surgery 11/2010; 126(5):1677-88. DOI:10.1097/PRS.0b013e3181ef8f65 · 3.33 Impact Factor