Cranial vault expansion by distraction osteogenesis

Clinical article

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  • 1 Departments of Neurosurgery and
  • | 2 Surgery, University of Colorado School of Medicine,
  • | 3 The Children's Hospital, and
  • | 4 Denver Health and Hospitals, Denver, Colorado
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Object

The object of this report is to present a conceptual and technical approach for expanding the cranial vault, by distraction osteogenesis, in patients with craniocephalic disproportion secondary to pancraniosynostosis and in patients with complex syndromic craniofaciosynostoses undergoing operations for aesthetic improvement.

Methods

The clinical characteristics, techniques used, outcome and complications for all patients who underwent cranial vault expansions with distraction osteogenesis in Children's Hospital of Denver were reviewed.

Results

Twenty-six cranial vault expansions were done in 24 patients. Nineteen patients presented with intracranial hypertension. Twelve of these had pancraniosynostosis and 8 had a syndromic diagnosis. Large segments of cranial bone were translated in a controlled manner for distances up to 30 mm. All but one of the patients with intracranial hypertension experienced complete resolution.

Conclusions

Cranial vault expansion by distraction osteogenesis has the great advantage, as the name implies, of generating new and vascularized autologous bone of the correct shape and in correct locations. The technique, although not simple and not risk free, is much less technically complicated and places patients at lower risk for the most serious complications than does single-stage vault expansion. Less soft tissue dissection and less devascularization of bone are required and there are no postoperative dead spaces. Distraction osteogenesis facilitates far greater vault expansions than do single-stage procedures and can be accomplished in any desired direction.

Abbreviation used in this paper:

MID = modular internal distracter.

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Contributor Notes

Address correspondence to: Ken R. Winston, M.D., 13123 East 16th Avenue, Aurora, Colorado 80045. email: winston.ken@tchden.org.
  • 1

    Akai T, , Iizuka H, & Kawakami S: Treatment of craniosynostosis by distraction osteogenesis. Pediatr Neurosurg 42:288292, 2006

  • 2

    Akizuki T, , Komuro Y, & Ohmori K: Distraction osteogenesis for craniosynostosis. Neurosurg Focus 9:3 E1, 2000

  • 3

    Albright AL, & Tyler-Kabara E: Slit-ventricle syndrome secondary to shunt-induced suture ossification. Neurosurgery 48:764770, 2001

  • 4

    Anderson PJ, , Harkness WJ, , Taylor W, , Jones BM, & Hayward RD: Anomalous venous drainage in a case of non-syndromic craniosynostosis. Childs Nerv Syst 13:97100, 1997

    • Search Google Scholar
    • Export Citation
  • 5

    Anderson PJ, , Tan E, & David DJ: Simultaneous multiple vector distraction for craniosynostosis syndromes. Br J Plast Surg 58:626631, 2005

    • Search Google Scholar
    • Export Citation
  • 6

    Aoki A: [Observation of pulpal blood flow and bone mineralization after alveolar distraction osteogenesis in a canine cleft model.]. Kokubyo Gakkai Zasshi 76:3744, 2009. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 7

    Bradley JP, , Gabbay JS, , Taub PJ, , Heller JB, , O'Hara CM, & Benhaim P, et al. : Monobloc advancement by distraction osteogenesis decreases morbidity and relapse. Plast Reconstr Surg 118:15851597, 2006

    • Search Google Scholar
    • Export Citation
  • 8

    Bristol RE, , Lekovic GP, & Rekate HL: The effects of craniosynostosis on the brain with respect to intracranial pressure. Semin Pediatr Neurol 11:262267, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Cho BC, , Hwang SK, & Uhm KI II: Distraction osteogenesis of the cranial vault for the treatment of craniofacial synostosis. J Craniofac Surg 15:135144, 2004

    • Search Google Scholar
    • Export Citation
  • 10

    Chung J, & Yoon SH: Rotating distraction osteogenesis in a child with secondary craniosyntostosis. J Craniofac Surg 17:557560, 2006

  • 11

    Codivilla A: On the means of lengthening in lower limbs, muscles, and tissues which are shortened through deformity. Am J Orthop Surg 2:353, 1905

    • Search Google Scholar
    • Export Citation
  • 12

    Cohen SR, , Boydston W, , Hudgins R, & Burstein FD: Monobloc and facial bipartition distraction with internal devices. J Craniofac Surg 10:244251, 1999

    • Search Google Scholar
    • Export Citation
  • 13

    Cohen SR, , Dauser RC, , Newman MH, & Muraszko K: Surgical techniques of cranial vault expansion for increases in intracranial pressure in older children. J Craniofac Surg 4:167176, 1993

    • Search Google Scholar
    • Export Citation
  • 14

    Cruz AA, , Akaishi PM, , Arnaud E, , Marchac D, & Renier D: Exorbitism correction of faciocraniosynostoses by monobloc frontofacial advancement with distraction osteogenesis. J Craniofac Surg 18:355360, 2007

    • Search Google Scholar
    • Export Citation
  • 15

    do Amaral CM, , Di Domizio G, , Tiziani V, , Galhardi F, , Buzzo CL, & Rinco T, et al. : Gradual bone distraction in craniosynostosis. Preliminary results in seven cases Scand. J Plast Reconstr Surg Hand Surg 31:2537, 1997

    • Search Google Scholar
    • Export Citation
  • 16

    Dowlati D, , Winston KR, , Ketch LL, , Quinones R, , Giller R, & Frattini A, et al. : Expansion cranioplasty with jackscrew distracters for craniosynostosis and intracranial hypertension in transplanted osteopetrosis. Pediatr Neurosurg 43:102106, 2007

    • Search Google Scholar
    • Export Citation
  • 17

    Eaton AC, , Marsh JL, & Pilgram TK: Transfusion requirements for craniosynostosis surgery in infants. Plast Reconstr Surg 95:277283, 1995

    • Search Google Scholar
    • Export Citation
  • 18

    Eide PK, , Helseth E, , Due-Tønnessen B, & Lundar T: Changes in intracranial pressure after calvarial expansion surgery in children with slit ventricle syndrome. Pediatr Neurosurg 35:195204, 2001

    • Search Google Scholar
    • Export Citation
  • 19

    Eley KA, , Witherow H, , Hayward R, , Evans R, , Young K, & Clark A, et al. : The evaluation of bony union after frontofacial distraction. J Craniofac Surg 20:275278, 2009

    • Search Google Scholar
    • Export Citation
  • 20

    Fearon JA, , Swift DM, & Bruce DA: New methods for the evaluation and treatment of craniofacial dysostosis-associated cerebellar tonsillar herniation. Plast Reconstr Surg 108:18551861, 2001

    • Search Google Scholar
    • Export Citation
  • 21

    Fitzgerald O'Connor EJ, , Marucci DD, , Jeelani NO, , Witherow H, , Richards R, & Dunaway DJ, et al. : Ocular advancement in monobloc distraction. Plast Reconstr Surg 123:15701577, 2009

    • Search Google Scholar
    • Export Citation
  • 22

    Fujimori Y, , Ueda K, & Oba S: Additional distraction osteogenesis after conventional fronto-orbital advancement. J Craniofac Surg 16:10641069, 2005

    • Search Google Scholar
    • Export Citation
  • 23

    Gough J, , Walker DG, , Theile R, & Tomlinson FH: The role of cranial expansion for craniocephalic disproportion. Pediatr Neurosurg 41:6169, 2005

    • Search Google Scholar
    • Export Citation
  • 24

    Greene CS Jr: Pancraniosynostosis after surgery for single sutural craniosynostosis. Pediatr Neurosurg 29:127132, 1998

  • 25

    Ilizarov GA: Transosseous Osteosynthesis. Theoretical and Clinical Aspects of the Regeneration and Growth of Tissue Heidelberg, Springer-Verlag, 1992. 3328

    • Search Google Scholar
    • Export Citation
  • 26

    Imai K, , Komune H, , Toda C, , Nomachi T, , Enoki E, & Sakamoto H, et al. : Cranial remodeling to treat craniosynostosis by gradual distraction using a new device. J Neurosurg 96:654659, 2002

    • Search Google Scholar
    • Export Citation
  • 27

    Kaban LB, , Seldin EB, , Kikinis R, , Yeshwant K, , Padwa BL, & Troulis MJ: Clinical application of curvilinear distraction osteogenesis for correction of mandibular deformities. J Oral Maxillofac Surg 67:9961008, 2009

    • Search Google Scholar
    • Export Citation
  • 28

    Kamoshima Y, , Sawamura Y, , Yoshino M, & Kawashima K: Frontofacial monobloc advancement using gradual bone distraction method. J Pediatr Surg 43:19441948, 2008

    • Search Google Scholar
    • Export Citation
  • 29

    Kobayashi S, , Honda T, , Saitoh A, & Kashiwa K: Unilateral coronal synostosis treated by internal forehead distraction. J Craniofac Surg 10:467472, 1999

    • Search Google Scholar
    • Export Citation
  • 30

    Komuro Y, , Hashizume K, , Koizumi T, , Miyajima M, , Nakanishi H, & Arai H: Cranial expansion with distraction osteogenesis for multiple-suture synostosis in school-aged children. J Craniofac Surg 20:457460, 2009

    • Search Google Scholar
    • Export Citation
  • 31

    Komuro Y, , Yanai A, , Hayashi A, , Nakanishi H, , Miyajima M, & Arai H: Cranial reshaping employing distraction and contraction in the treatment of sagittal synostosis. Br J Plast Surg 58:196201, 2005

    • Search Google Scholar
    • Export Citation
  • 32

    Lee JA, , Park DH, , Yoon SH, & Chung J: Distractor breakage in cranial distraction osteogenesis for children with craniosynostosis. Pediatr Neurosurg 44:216220, 2008

    • Search Google Scholar
    • Export Citation
  • 33

    Mackenzie KA, , Davis C, , Yang A, & MacFarlane MR: Evolution of surgery for sagittal synostosis: the role of new technologies. J Craniofac Surg 20:129133, 2009

    • Search Google Scholar
    • Export Citation
  • 34

    Malagon HH, , Romo GW, , Quintero Mosqueda FR, & Magaña FG: Multivectorial, external halo-assisted midface distraction in patients with severe hypoplasia. J Craniofac Surg 19:16631669, 2008

    • Search Google Scholar
    • Export Citation
  • 35

    McCarthy JG, , Glasberg SB, , Cutting CB, , Epstein FJ, , Grayson BH, & Ruff G, et al. : Twenty-year experience with early surgery for craniosynostosis: II. The craniofacial synostosis syndromes and pansynostosis—results and unsolved problems. Plast Reconstr Surg 96:284298, 1995

    • Search Google Scholar
    • Export Citation
  • 36

    McCarthy JG, , Stelnicki EJ, , Mehrara BJ, & Longaker MT: Distraction osteogenesis of the craniofacial skeleton. Plast Reconstr Surg 107:18121827, 2001

    • Search Google Scholar
    • Export Citation
  • 37

    Meling TR, , Due-Tønnessen BJ, , Høgevold HE, , Skjelbred P, & Arctander K: Monobloc distraction osteogenesis in pediatric patients with severe syndromal craniosynostosis. J Craniofac Surg 15:9901001, 2004

    • Search Google Scholar
    • Export Citation
  • 38

    Meling TR, , Hans-Erik H, , Per S, & Due-Tonnessen BJ: Le Fort III distraction osteogenesis in syndromal craniosynostosis. J Craniofac Surg 17:2839, 2006

    • Search Google Scholar
    • Export Citation
  • 39

    Molina F, & Ortiz Monasterio F: Mandibular elongation and remodeling by distraction: a farewell to major osteotomies. Plast Reconstr Surg 96:825842, 1995

    • Search Google Scholar
    • Export Citation
  • 40

    Nada RM, , Sugar AW, , Wijdeveld MG, , Borstiap WA, , Clauser L, & Hoffmeister B, et al. : Current practice of distraction osteogenesis for craniofacial anomalies in Europe: a web based survey. J Craniomaxillofac Surg 38:8389, 2010

    • Search Google Scholar
    • Export Citation
  • 41

    Nishimoto S, , Oyama T, , Nagashima T, , Osaki Y, , Yoshimura Y, & Fukuda K, et al. : Lateral orbital expansion and gradual frontoorbital advancement: an option to treat severe syndromic craniosynostosis. J Craniofac Surg 19:16221627, 2008

    • Search Google Scholar
    • Export Citation
  • 42

    Nishimoto S, , Oyama T, , Nagashima T, , Shimizu F, , Tsugawa T, & Takeda M, et al. : Gradual distraction fronto-orbital advancement with ‘floating forehead’ for patients with syndromic craniosynostosis. J Craniofac Surg 17:497505, 2006

    • Search Google Scholar
    • Export Citation
  • 43

    Nonaka Y, , Oi S, , Miyawaki T, , Shinoda A, & Kurihara K: Indication for and surgical outcomes of the distraction method in various types of craniosynostosis. Advantages, disadvantages, and current concepts for surgical strategy in the treatment of craniosynostosis. Childs Nerv Syst 20:702709, 2004

    • Search Google Scholar
    • Export Citation
  • 44

    Park DH, , Chung J, & Yoon SH: The role of distraction osteogenesis in children with secondary craniosynostosis after shunt operation in early infancy. Pediatr Neurosurg 45:437445, 2009

    • Search Google Scholar
    • Export Citation
  • 45

    Polley JW, & Figueroa AA: Management of severe maxillary deficiency in childhood and adolescence through distraction osteogenesis with an external, adjustable, rigid distraction device. J Craniofac Surg 8:181186, 1997

    • Search Google Scholar
    • Export Citation
  • 46

    Rich PM, , Cox TC, & Hayward RD: The jugular foramen in complex and syndromic craniosynostosis and its relationship to raised intracranial pressure. AJNR Am J Neuroradiol 24:4551, 2003

    • Search Google Scholar
    • Export Citation
  • 47

    Sabry MZ, , Wornom IL III, & Ward JD: Results of cranial vault reshaping. Ann Plast Surg 47:119126, 2001

  • 48

    Sanchukov M, , Cherkashin AM, & Cope JB, Distraction osteogenesis: origin and evolution. McNamara JA, , Trotman CA, & Ferrara A: Distraction Osteogenesis and Tissue Engineering Ann Arbor, University of Michigan Press, 1998. 135

    • Search Google Scholar
    • Export Citation
  • 49

    Satoh K, , Mitsukawa N, , Tosa Y, & Kadomatsu K: Le Fort III midfacial distraction using an internal distraction device for syndromic craniosynostosis: device selection, problems, indications, and a proposal for use of a parallel bar for device-setting. J Craniofac Surg 17:10501058, 2006

    • Search Google Scholar
    • Export Citation
  • 50

    Scott JR, , Isom CN, , Gruss JS, , Salemy S, , Ellenbogen RG, & Avellino A, et al. : Symptom outcomes following cranial vault expansion for craniosynostosis in children older than 2 years. Plast Reconstr Surg 123:289299, 2009

    • Search Google Scholar
    • Export Citation
  • 51

    Sugawara Y, , Hirabayashi S, , Sakurai A, & Harii K: Gradual cranial vault expansion for the treatment of craniofacial synostosis: a preliminary report. Ann Plast Surg 40:554565, 1998

    • Search Google Scholar
    • Export Citation
  • 52

    Taylor WJ, , Hayward RD, , Lasjaunias P, , Britto JA, , Thompson DN, & Jones BM, et al. : Enigma of raised intracranial pressure in patients with complex craniosynostosis: the role of abnormal intracranial venous drainage. J Neurosurg 94:377385, 2001

    • Search Google Scholar
    • Export Citation
  • 53

    Toth BA, , Kim JW, , Chin M, & Cedars M: Distraction osteogenesis and its application to the midface and bony orbit in craniosynostosis syndromes. J Craniofac Surg 9:100122, 1998

    • Search Google Scholar
    • Export Citation
  • 54

    Uemura T, , Hayashi T, , Satoh K, , Mitsukawa N, , Yoshikawa A, & Suse T, et al. : Three-dimensional cranial expansion using distraction osteogenesis for oxycepahy. J Craniofac Surg 14:2936, 2003

    • Search Google Scholar
    • Export Citation
  • 55

    Wagner JD, , Cohen SR, , Maher H, , Dauser RC, & Newman MH: Critical analysis of results of craniofacial surgery for nonsyndromic bicoronal synostosis. J Craniofac Surg 6:3239, 1995

    • Search Google Scholar
    • Export Citation
  • 56

    Watanabe Y, & Akizuki T: Prevention and treatment of penicillin-resistant Streptococcus pneumoniae meningitis after intracraniofacial surgery with distraction osteogenesis. J Craniofac Surg 19:15421548, 2008

    • Search Google Scholar
    • Export Citation
  • 57

    White N, , Evans M, , Dover MS, , Noons P, , Solanki G, & Nishikawa H: Posterior calvarial vault expansion using distraction osteogenesis. Childs Nerv Syst 25:231236, 2009

    • Search Google Scholar
    • Export Citation
  • 58

    Winston KR, & Breeze RE: Hydraulic regulation of brain parenchymal volume. Neurol Res 13:237247, 1991

  • 59

    Yano H, , Tanaka K, , Sueyoshi O, , Takahashi K, , Hirata R, & Hirano A: Cranial vault distraction: its illusionary effect and limitation. Plast Reconstr Surg 117:193201, 2006

    • Search Google Scholar
    • Export Citation
  • 60

    Yonehara Y, , Hirabayashi S, , Sugawara Y, , Sakurai A, & Harii K: Complications associated with gradual cranial vault distraction osteogenesis for the treatment of craniofacial synostosis. J Craniofac Surg 14:526528, 2003

    • Search Google Scholar
    • Export Citation

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