Multidirectional cranial distraction osteogenesis technique for treating bicoronal synostosis

Craniosynostosis: Current Evaluation and Management

ABSTRACT

Craniosynostosis is characterized by the premature fusion of one or more cranial sutures, which can lead to abnormal skull shape and restricted skull growth. Although most cases are present in isolation, some are associated with genetic syndromes, such as Pfeiffer, Muenke, Couzon, Apert, and others, which increases the complexity of care. Today, a spectrum of surgical options to treat craniosynostosis are available and range from traditional open cranial vault remodeling to newer and less invasive suturectomy-based techniques. Which procedure is offered to a patient depends on not only the specific synostosis pattern but also factors such as patient age, the need for additional procedures or interventions, and evidence of elevated intracranial pressure. Thorough consultations with families to discuss achievable goals for cosmesis and function are essential in providing optimal care to each impacted child.

One-piece fronto-orbital distraction osteogenesis without bandeau in patients with coronal craniosynostosis: A five-year follow-up retrospective study of 45 consecutive patients

This study aimed to review the surgical outcomes, complications, and long-term relapses in patients with unilateral or bilateral coronal craniosynostosis, who underwent one-piece fronto-orbital distraction osteogenesis (FODO) without bandeau. The cephalic index, frontal angle, and supraorbital symmetry ratio were measured on the initial and follow-up computed tomography images. Esthetic outcomes were evaluated using the Whitaker classification. 45 patients were included in this study. The average follow-up interval was 5.4 ± 1.1 years (range 2.5-8.5 years). In patients with bilateral coronal craniosynostosis, the frontal angle decreased with a relapse ratio of -2.8 ± 4.3% during long-term follow-up compared with that during short-term follow-up (p = 0.028). In patients with unilateral coronal craniosynostosis, the supraorbital symmetry ratio decreased slightly, with a relapse ratio of -3.8 ± 2.6% during long-term follow-up (p = 0.017). Complications included dural tears during osteotomy (n = 2), early distractor removal (n = 2), and wound problems (n = 3). Within the limitations of the study it seems that one-piece fronto-orbital distraction osteogenesis (FODO) generates successful and sustainable results even in the long term. Therefore, this treatment option should be considered for patients with unilateral and bilateral coronal craniosynostoses whenever appropriate.

Accelerated cranial distraction protocol for one-piece fronto-orbital distraction osteogenesis without bandeau in patients with craniosynostosis

This study aimed to compare the bony relapse ratios of standard and accelerated distraction protocols (ADP) in one-piece fronto-orbital distraction osteogenesis (DO). Patients with unilateral or bilateral coronal synostoses who underwent one-piece fronto-orbital DO were included. The accelerated cranial distraction protocol included a 3-day latency period and a distraction rate of 1-2 mm/day, followed by a 4-week consolidation period. Intracranial volume was measured using computed tomography (CT) before the surgery, at the end of the consolidation period, and 1 year after the removal of distractors. The intracranial volume changes and relapse ratios were calculated. This study included 32 patients; of these, 16 were included in each of the ADP and standard protocol (SP) groups. The mean ages were 1.4 years and 1.6 years in the ADP and SP groups, respectively (p = 0.895). In the ADP and SP groups, the expanded volumes were 270.9 ± 90.3 cm³ and 284.6 ± 149.7 cm³ (p = 0.91) and the growth-corrected expanded volumes were 162.1 ± 67.5 cm³ and 177.1 ± 105.2 cm³, respectively (p = 0.867). The relapse and growth-corrected relapse ratios showed no significant differences between the two groups, suggesting similar stability between the two protocols. The relapse ratios were 7.1 ± 4.8% and 7.3 ± 5.0% (p = 0.91) and the growth-corrected relapse ratios were -3.0 ± 3.3% and -2.4 ± 2.7%, respectively (p = 0.498). Within the limitations of the study, it seems that the ADP can shorten the distraction period without compromising stability. This may contribute to resolving the disadvantages and highlighting the advantages of DO.

Distraction osteogenesis in craniosynostosis

PURPOSE OF REVIEW

Craniosynostosis, a condition of premature cranial suture fusion, can have significantly detrimental effects on development and growth due to sequelae of increased intracranial hypertension (ICP), exophthalmos, and upper airway obstruction. Evolving surgical treatments now include distraction osteogenesis (DO) due to its many benefits relative to standard cranial vault remodeling procedures. This article provides an overview and update of different surgical applications of DO for patients with craniosynostosis.

RECENT FINDINGS

DO has been utilized successfully for single and multisuture craniosynostosis with or without midface hypoplasia to increase intracranial volume, decrease ICP and improve aesthetics. It has been applied in single suture synostosis, posterior vault DO, fronto-orbital advancement, monobloc DO and Le Fort III DO. DO has been applied through modification of traditional surgical procedures with success in maintaining goals of surgery while reducing risk.

SUMMARY

DO is still a relatively new and evolving surgical technique for patients with syndromic and nonsyndromic craniosynostosis. With promising benefits, consideration for each procedure should be weighed until longer-term data is available.