Complete posterior cranial vault distraction osteogenesis to correct Chiari malformation type I associated with craniosynostosis

Hojin Park MD, PhD1, Somin Oh MD1, Jong Woo Choi MD, PhD, MMM1, and Young Shin Ra MD, PhD2
View More View Less
  • 1 Department of Plastic and Reconstructive Surgery, and
  • | 2 Department of Neurosurgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, Korea
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

OBJECTIVE

Posterior vault distraction osteogenesis (PVDO) is an effective tool to increase intracranial volume and expand the posterior cranial fossa. During PVDO, the authors extended osteotomy posterior to the foramen magnum to fully expand the posterior cranial fossa. The aim of this study was to investigate the efficacy of complete PVDO in posterior fossa expansion and treatment of Chiari malformation type I (CM-I) in patients with craniosynostosis.

METHODS

Patients with craniosynostosis who had undergone complete PVDO between January 2012 and May 2020 were reviewed retrospectively. A coronal osteotomy extending to the foramen magnum was performed and the foramen magnum was decompressed by removing its posterior rim with a 1-mm Kerrison rongeur. Four distractor devices were placed and the vector of distraction was controlled from the posterior to the inferior-posterior direction, depending on the deformity. Changes in the intracranial volume, posterior cranial fossa area, and cerebellar tonsillar descent were measured after complete PVDO by using CT and MRI.

RESULTS

A total of 11 patients with craniosynostosis and concurrent CM-I were included in the study. The mean age was 34.6 ± 24.0 months (continuous variables are expressed as the mean ± SD throughout). One patient had sleep apnea, which was consistent with CM-I, and another patient had a headache, which was nonspecific. The intracranial volume increased from 1179.6 ± 180.2 cm3 to 1440.6 ± 251.5 cm3 (p = 0.003; 24.5% increase compared to the preoperative volume). The posterior skull base area increased from 44.9 ± 19.3 cm2 to 72.7 ± 18.1 cm2 (p = 0.004). Cerebellar tonsillar descent decreased in all 11 patients after complete PVDO (preoperative: 10.8 ± 3.7 mm, postoperative: 2.7 ± 3.0 mm; p = 0.003). Among the 11 patients, 5 showed complete resolution of cerebellar tonsillar herniation.

CONCLUSIONS

Complete PVDO can more efficiently expand the posterior cranial fossa, unlike conventional methods. Moreover, it helps to relieve cerebellar tonsillar herniation. Complete PVDO is a powerful tool to increase the intracranial and posterior fossa volumes in patients with craniosynostosis and concurrent CM-I.

ABBREVIATIONS

CM-I = Chiari malformation type I; CTD = cerebellar tonsillar descent; CVR = cranial vault remodeling; FOA = fronto-orbital advancement; PVDO = posterior vault distraction osteogenesis.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Zhao JL, Li MH, Wang CL, Meng W. A systematic review of Chiari I malformation: techniques and outcomes. World Neurosurg. 2016;88:714.

  • 2

    Poretti A, Ashmawy R, Garzon-Muvdi T, Jallo GI, Huisman TA, Raybaud C. Chiari type 1 deformity in children: pathogenetic, clinical, neuroimaging, and management aspects. Neuropediatrics. 2016;47(5):293307.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Cahan LD, Bentson JR. Considerations in the diagnosis and treatment of syringomyelia and the Chiari malformation. J Neurosurg. 1982;57(1):2431.

  • 4

    Isu T, Iwasaki Y, Akino M, Abe H. Hydrosyringomyelia associated with a Chiari I malformation in children and adolescents. Neurosurgery. 1990;26(4):591597.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Ahmad F, Evans M, White N, Nishikawa H, Dover S, Solanki G, Rodrigues D. Amelioration of Chiari type 1 malformation and syringomyelia following posterior calvarial distraction in Crouzon’s syndrome—a case report. Childs Nerv Syst. 2014;30(1):177179.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Feller CN, Jensen JN, Lew SM. Chiari malformation type 1 and syringomyelia in a patient with prior surgically-treated sagittal synostosis effectively treated with posterior cranial vault distraction osteogenesis. J Craniofac Surg. 2021;32(6):21102113.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Cinalli G, Spennato P, Sainte-Rose C, Arnaud E, Aliberti F, Brunelle F, et al. Chiari malformation in craniosynostosis. Childs Nerv Syst. 2005;21(10):889901.

  • 8

    Mathijssen IM. Guideline for care of patients with the diagnoses of craniosynostosis: working group on craniosynostosis. J Craniofac Surg. 2015;26(6):17351807.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Swanson JW, Samra F, Bauder A, Mitchell BT, Taylor JA, Bartlett SP. An algorithm for managing syndromic craniosynostosis using posterior vault distraction osteogenesis. Plast Reconstr Surg. 2016;137(5):829e841e.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Komuro Y, Shimizu A, Shimoji K, Miyajima M, Arai H. Posterior cranial vault distraction osteogenesis with barrel stave osteotomy in the treatment of craniosynostosis. Neurol Med Chir (Tokyo). 2015;55(8):617623.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Goldstein JA, Paliga JT, Bailey RL, Heuer GG, Taylor JA. Posterior vault distraction with midface distraction without osteotomy as a first stage for syndromic craniosynostosis. J Craniofac Surg. 2013;24(4):12631267.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Steinbacher DM, Skirpan J, Puchała J, Bartlett SP. Expansion of the posterior cranial vault using distraction osteogenesis. Plast Reconstr Surg. 2011;127(2):792801.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    White N, Evans M, Dover MS, Noons P, Solanki G, Nishikawa H. Posterior calvarial vault expansion using distraction osteogenesis. Childs Nerv Syst. 2009;25(2):231236.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Jeong WS, Choi JW, Oh TS, Koh KS, Cho YH, Hong SH, Rah YS. Long-term follow-up of one-piece fronto-orbital advancement with distraction but without a bandeau for coronal craniosynostosis: review of 26 consecutive cases. J Craniomaxillofac Surg. 2016;44(9):12521258.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Goldstein JA, Paliga JT, Wink JD, Low DW, Bartlett SP, Taylor JA. A craniometric analysis of posterior cranial vault distraction osteogenesis. Plast Reconstr Surg. 2013;131(6):13671375.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Choi M, Flores RL, Havlik RJ. Volumetric analysis of anterior versus posterior cranial vault expansion in patients with syndromic craniosynostosis. J Craniofac Surg. 2012;23(2):455458.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Serlo WS, Ylikontiola LP, Lähdesluoma N, Lappalainen OP, Korpi J, Verkasalo J, Sàndor GK. Posterior cranial vault distraction osteogenesis in craniosynostosis: estimated increases in intracranial volume. Childs Nerv Syst. 2011;27(4):627633.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Mazzaferro DM, Ter Maaten NS, Wes AM, Naran S, Bartlett SP, Taylor JA. A craniometric analysis of the posterior cranial base after posterior vault distraction. J Craniofac Surg. 2019;30(6):16921695.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Lo WB, Thant KZ, Kaderbhai J, White N, Nishikawa H, Dover MS, et al. Posterior calvarial distraction for complex craniosynostosis and cerebellar tonsillar herniation. J Neurosurg Pediatr. 2020;26(4):421430.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Lin LO, Zhang RS, Hoppe IC, Paliga JT, Swanson JW, Bartlett SP, Taylor JA. Onset and resolution of Chiari malformations and hydrocephalus in syndromic craniosynostosis following posterior vault distraction. Plast Reconstr Surg. 2019;144(4):932940.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Scott WW, Fearon JA, Swift DM, Sacco DJ. Suboccipital decompression during posterior cranial vault remodeling for selected cases of Chiari malformations associated with craniosynostosis. J Neurosurg Pediatr. 2013;12(2):166170.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Koechlin NO, Abuhusain HJ, Gunawardena M, Auschwitz TS, Teo C. Symptomatic outcome after bone-only suboccipital decompression in adult patients with Chiari type I malformations in the absence of hydromyelia or hydrocephalus. J Neurol Surg A Cent Eur Neurosurg. 2017;78(4):344349.

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 879 879 639
Full Text Views 111 111 78
PDF Downloads 120 120 72
EPUB Downloads 0 0 0