ISCFS 2019 Abstract Supplement
S2-07 SESSION 2: POSTERIOR VAULT DISTRACTION EFFECTIVENESS OF DISTRACTOR-MEDIATED AND BRAIN-MEDIATED POSTERIOR VAULT EXPANSION IN COMPLEX CRANIOSYNOSTOSIS
Introduction: Correction of brachycephaly presents a challenge to the surgeon with numerous, often syndromic associations. Posterior cranial vault distraction has emerged as an effective method to increase the intracranial volume. A posterior osteotomy with brain-directed expansion (rather than distractor-mediated) has also been used to treat this condition in the youngest patients with the benefits of avoiding distractor-related complications and the subsequent device removal. This study aims to compare these techniques.
Methods: A retrospective review of patients treated by posterior expansion was performed at a single institution (Hôpital Necker, Paris, France). Two groups of patients were studied and compared with demographic data: (1) all Patients with mixed syndromes and postoperative scans taken at random timepoints; (2) homogenous subgroups of Crouzon syndrome and Mercedes type with 3-month-postoperative scans. CT imaging was analyzed comparing pre- and post-operative scans for intracranial volume. Postoperative change in intracranial volume was assessed as the primary outcome measure.
Results: 1. Twenty-two overall patients were identified with 11 in the group receiving a posterior osteotomy alone and 11 receiving a posterior expansion by distraction. The average age of surgery was 9.04 months for the osteotomy group and 14.3 months for the distraction group. The average postoperative time between surgery and the CT scan used for analysis was 3.56 months (osteotomy) and 1.66 months (distraction). The average increase in cranial vault volume was 215.04 mL (28.02%) after osteotomy alone and 317.51 mL (36.31%) after distraction. 2. Subgroups with Crouzon and Mercedes at 3-month-postoperative scans. There was no statistically significant difference between distractor-mediated and brain mediated expansion, but samples were too small.
Conclusion: This pilot study lacked the statistical power to detect a significant difference between distractor-mediated and brain-mediated posterior vault expansion. Further studies are required to determine the effectiveness of brain-mediated posterior vault expansion in the younger and more severe cases. Nevertheless, our preliminary results may indicate that the efficiencies of brain-mediated vs distraction-mediated expansions are not massively different in younger patients.Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.