Internal Distraction Osteogenesis to Correct Symptomatic Cephalocranial Disproportion

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.