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Single-stage Total Cranial Vault Remodeling for Correction of Turricephaly: Description of a New Technique

Rottgers, Stephen Alex, MD*; Ganske, Ingrid, MD, MPA; Citron, Isabelle, BmBCH; Proctor, Mark, MD; Meara, John G., MD, DMD, MBA

Plastic and Reconstructive Surgery – Global Open: August 8, 2018 - Volume Latest Articles - Issue - p
doi: 10.1097/GOX.0000000000001800
Latest Articles: PDF Only

Background: Turricephaly is considered one of the most difficult cranial deformities to correct as addressing cranial height can result in increased intracranial pressure. We describe a new technique of total calvarial remodeling with bony transposition to simultaneously correct turricephaly and brachycephaly while preserving intracranial volume.

Methods: A retrospective review of patients undergoing single-stage cranial vault remodeling by a single surgeon (J.G.M.) at a single center between 2007 and 2015 was performed. The procedure consists of a frontal bandeau followed by a 1 cm 360o axial strip craniectomy. The strip is then rotated 90 degrees into a coronal orientation and interposed between fronto-parietal and parito-occipital segments. Modification for occipital widening can also be performed.

Results: Six patients with turribrachycephaly underwent the procedure over the 8-year period. Four patients were operated at less than 1 year of age, one patient underwent surgery at 2 years, and one at 9 years. Mean operative time was 4 hours, and mean transfusion was 300cc. There were no major complications. Mean cranial height reduction achieved was 1.6 cm (range, 1.0–2.0 cm), and mean anterior–posterior expansion was 3.4 cm (range, 2.3–4.5 cm). Patients also showed improvement in supraorbital retrusion.

Conclusion: Single-stage cranial vault remodeling with axial strip craniectomy and coronal interposition is safe and allows for simultaneous correction of turricephaly and brachycephaly while preserving intracranial volume.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

From the *Pediatric Plastic and Reconstructive Surgery, Johns Hopkins All Children’s Hospital, St Petersburg, Fla.

Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass.

Published online 8 August 2018.

Received for publication December 20, 2017; accepted April 4, 2018.

Isabelle Citron is funded through the Frank Knox Scholarship at Harvard University.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by Boston Children’s Hospital and the HOPE Foundation.

Isabelle Citron, BmBCH, Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, E-mail: Isabelle.Citron@gmail.com

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.