Expansion of the Posterior Cranial Vault Using Distraction Osteogenesis

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Abstract
Expansion of the posterior cranial vault more profoundly enlarges intracranial volume compared with the anterior region. Conventional vault remodeling techniques are limited by scalp forces and may relapse with supine positioning. The purpose of this study was to demonstrate the efficacy of posterior vault distraction and evaluate perioperative variables compared with conventional methods in syndromic children. This was a retrospective analysis of consecutive children who underwent posterior vault expansion using distraction osteogenesis. Information was compiled regarding demographics, perioperative details, distraction protocol, and complications. Eight children were identified, two boys and six girls. Diagnoses of Apert, Crouzon, Saethre-Chotzen, and Pfeiffer syndromes were present. Chiari malformation was present in two children. The posterior distraction procedure was undertaken at a mean of 21 months (range, 5 to 36 months). Mean operative time was 3.8 hours (range, 2.6 to 5 hours), blood loss averaged 487 ml (range, 300 to 2000 ml), and hospital stay was 3.25 days (range, 2 to 4 days). A latency period of 72 hours and rate of 2/3 mm/day was used in three patients, and 1 mm/day was used in five children. The mean advancement was 23 mm (range, 19 to 32 mm) and consolidation was 77 days (range, 42 to 100 days). One child experienced fracture of distraction arms during the activation period. Mean follow-up was 278 days (range, 90 to 548 days). These preliminary findings indicate that posterior vault distraction is a viable technique with a favorable perioperative profile compared with conventional treatment. Posterior distraction can be the initial strategy with which to address intracranial pressure, allowing delay of definitive frontoorbital advancement until later in childhood.