Early cranial vault distraction for a more balanced and enhanced expansion: a 3D craniometric analysis of anterior versus posterior distraction osteogenesis in patients with craniosynostosis

Sungmi Jeon MD1, Jee Hyeok Chung MD, PhD1, Sukwha Kim MD, PhD2,3, Seung-Ki Kim MD, PhD4, Ji Hoon Phi MD, PhD4, Ji Yeoun Lee MD, PhD4, Kyung Hyun Kim MD4, Kyu-Chang Wang MD, PhD5, and Byung Jun Kim MD1
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  • 1 Division of Pediatric Plastic Surgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul;
  • | 2 Department of Plastic Surgery, CHA Bundang Medical Center, Gyeonggi-do;
  • | 3 Medical Big Data Research Center, Seoul;
  • | 4 Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul; and
  • | 5 Center for Rare Cancers, Neuro-Oncology Clinic, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
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OBJECTIVE

Posterior distraction osteogenesis (DO) is widely accepted for the treatment of craniosynostosis. The aim of this study was to quantitatively compare the effect of DO on the cranial vault according to the age of the patient and direction of distraction.

METHODS

This was a retrospective study of patients with craniosynostosis who underwent DO in the anteroposterior direction. Postdistraction changes in intracranial volume (ICV), anteroposterior distance, biparietal distance, cranial height, and frontal bossing angle were measured using Mimics software on CT scans. Craniometric data were analyzed using a multivariate regression model.

RESULTS

Thirty-two patients (16 anterior and 16 posterior DOs) were included in the study. The mean ICV increase in the anterior and posterior DO group was 211 cm3 (range 142–281 cm3) and 214 cm3 (range 150–279 cm3), respectively. Patients who were aged 1 year or younger showed a greater percentage increase in ICV than patients older than 1 year. In the anterior DO group, a more balanced increase in both anterior and posterior anteroposterior distance was observed in patients aged 1 year or younger when compared to patients older than 1 year. In the posterior DO group, a bigger expansion and smoother contour in the posterior cranial fossa was observed in patients aged 1 year or younger.

CONCLUSIONS

Both anterior and posterior DO are effective surgical options for expanding the cranial vault in patients with craniosynostosis. Early distraction appeared to show greater morphological changes in the growing cranial vault than those predicted with the vector of distraction.

ABBREVIATIONS

APD = anteroposterior distance; BPD = biparietal distance; CH = cranial height; DO = distraction osteogenesis; FH = Frankfurt horizontal; FOA = fronto-orbital advancement; ICV = intracranial volume.
Illustration from Cinalli et al. (pp 119–127). Printed with permission from © CC Medical Arts.

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