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Semin Plast Surg 2014; 28(04): 163-178
DOI: 10.1055/s-0034-1390169
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Posterior Cranial Vault Distraction Osteogenesis: Evolution of Technique

Juling Ong
1   Department of Craniofacial and Reconstructive Plastic Surgery, Dell Children's Medical Center of Central Texas, Austin, Texas
,
Raymond J. Harshbarger III
1   Department of Craniofacial and Reconstructive Plastic Surgery, Dell Children's Medical Center of Central Texas, Austin, Texas
,
Patrick Kelley
1   Department of Craniofacial and Reconstructive Plastic Surgery, Dell Children's Medical Center of Central Texas, Austin, Texas
,
Timothy George
1   Department of Craniofacial and Reconstructive Plastic Surgery, Dell Children's Medical Center of Central Texas, Austin, Texas
› Author Affiliations
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Publication History

Publication Date:
04 November 2014 (online)

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Abstract

The rapid growth of the brain in the first few years of life drives the expansion of the cranial vault. This expansion occurs primarily at the cranial sutures; premature fusion of these results in growth restriction perpendicular to the axis of the suture. The result of this is physical deformation of the cranial and facial skeleton, as well as the distortion of the underling brain and its physiology. These patients can present with symptoms of raised intracranial pressure, neurodevelopmental delay, as well as the morphological features of craniosynostosis. Acquired conditions such as the slit ventricle syndrome may also result in cephalocranial disproportion with these clinical features. Traditional vault remodeling surgery is able to correct the physical abnormalities as well as correcting cephalocranial disproportion. Its limitations include the degree of scalp expansion achievable as well as resulting defects in the bone. The use of distraction osteogenesis of the cranial vault permits a controlled expansion in a predetermined vector in a gradual manner. When used in the calvarium, this combines the benefits of tissue expansion on the scalp, as well as stimulating the production of new bone, reducing the defects resulting from expansion.

In this review, the authors describe some of the surgical considerations important to the use of this technique. This includes the relevant anatomy and technical aspects illustrated with the use of clinical cases. Finally, they present a summary of their experience and discuss the complications associated with cranial vault distraction osteogenesis.

Keywords

osteogenesis - distraction osteogenesis - posterior cranial vault expansion - craniosynostosis - syndromic craniosynostosis - distraction devices
 

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