Posterior vault distraction technique: how I do it.

Posterior cranial vault distraction is an effective technique when a significant increase in the intracranial volume is required in patients with craniosynostoses. This technique has been proven to be safe and time saving and usually is associated with low perioperative morbidity as well as low intraoperative bleeding. Herein a technique is presented starting from the preoperative planning, describing the surgical steps of the operation and the postoperative distraction protocol used by the authors. The authors present important tips and tricks aiming to minimise complications and undesired events.

Experience with resorbable sonic pins for the attachment of distraction devices in posterior cranial vault distraction operations.

BACKGROUND: Distraction techniques are effective methods for the treatment of craniosynostoses when a significant gain of an intracranial volume is required. However, this technique raises some challenges at different stages of the treatment. While installing the distractors in patients with thin calvarial bone, there is a risk of dural damage from the titanium screws. The need for wide exposure of the devices and the screws during removal causes soft tissue damage and bleeding. OBJECTIVE: This study aimed to evaluate sonic pin use in the distraction procedures. METHODS: Resorbable sonic pins were used in 11 consecutive posterior cranial vault distraction procedures to attach distraction devices to the calvarial bone. RESULTS: This method allowed for a less traumatic and faster removal of the devices without the risk of leaving foreign bodies in the wound. In three out of 11 cases on follow-up, displacement of proximal distractor footplate and partial relapse of distraction were detected. Though there was a smaller volume increase in these patients, all of them benefited clinically from the PCVD and did not require reoperations. CONCLUSIONS: This method allows a strong and stable attachment of the distractor devices to the cranial vault bones with a reduced risk of dural tears due to the screws. It also allows for easier and less traumatic device removal.

Introduction of spring-assisted cranioplasty for scaphocephaly in Russia: first cases evaluated using detailed craniometry and principal component analysis.

Spring-assisted cranioplasty (SAC) was recently introduced in Moscow. This study provides a detailed analysis of the results of the first 14 SAC cases in Russia. The patients underwent a computed tomography scan before surgery and prior to spring removal 3 months later. Fourteen cases (10 males and 4 females) were operated on, with a mean surgery time of 56 ± 14 min. All operations were uneventful, with a mean hospital stay of 4.2 days. Detailed craniometry of the 10 male patients and their matched controls revealed that SAC induced changes in the shape of the entire skull. The cranial index of the male patients increased from 68.2 to 72.3, whereas it remained stable at ∼80 for the controls. The anterior and middle skull heights were significantly larger in cases as compared with controls but shifted toward normal levels following SAC. Additionally, SAC increased parietal bone curvature, and principal component analysis showed that post-SAC morphological changes in patients were comparable to normal growth changes in the skull morphology of the controls. However, several months after the operation, patients continued to display a clearly distinct cranial morphology as compared with that of controls. These results indicated that SAC is a safe technique that showed good surgical results immediately after introduction.