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Open Access 21-06-2024 | Craniosynostosis | Research

Early posterior vault distraction osteogenesis changes the syndromic craniosynostosis treatment paradigm: long-term outcomes of a 23-year cohort study

Authors: Meagan Wu, Sarah L. Barnett, Benjamin B. Massenburg, Jinggang J. Ng, Dominic J. Romeo, Jesse A. Taylor, Scott P. Bartlett, Jordan W. Swanson

Published in: Child's Nervous System | Issue 9/2024

Abstract

Background

Early surgical management of syndromic craniosynostosis varies widely between centers, with patients typically undergoing multiple intracranial procedures through childhood. This study evaluates the long-term impact of early posterior vault distraction osteogenesis (PVDO) versus conventional treatment paradigms on the number and timing of subsequent craniofacial procedures.

Methods

We retrospectively analyzed the longitudinal operative patterns of patients with syndromic craniosynostosis treated from 2000 to 2023 with greater than five years of follow-up. Outcomes of patients who underwent early PVDO and conventional vault reconstruction were compared.

Results

Fifty-five patients met the inclusion criteria (30 PVDO and 25 conventional). Age at initial vault surgery was similar between the PVDO and conventional cohorts (7.6 vs. 8.8 months), as were baseline craniometrics (p > 0.05). Multiple fronto-orbital advancement (FOA) procedures were performed in only 1/30 (3%) PVDO-treated patient versus 12/25 (48%) conventionally-treated patients (p < 0.001). Twelve (40%) PVDO-treated patients did not undergo FOA at all. Among patients with Apert and Crouzon syndromes, fewer PVDO-treated patients required FOA prior to midface surgery (33% vs. 92%, p = 0.004) or repeat FOA (6% vs. 50%, p = 0.005) compared to conventionally-treated patients. Among patients with Muenke and Saethre–Chotzen syndromes, a similar proportion of patients required FOA in the PVDO and conventional cohorts (91% vs. 100%, p = 0.353), though no PVDO-treated patients required repeat FOA (0% vs. 44%, p = 0.018).

Conclusions

Early PVDO is associated with a reduction in the high burden of both FOA and, critically, revisionary frontal procedures which are commonly seen in conventionally-treated patients with syndromic craniosynostosis.

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Forrest CR, Hopper RA (2013) Craniofacial syndromes and surgery. Plast Reconstr Surg 131(1):86e–109e. https://doi.org/10.1097/PRS.0b013e318272c12bCrossRefPubMed

Swanson JW, Samra F, Bauder A, Mitchell BT, Taylor JA, Bartlett SP (2016) An algorithm for managing syndromic craniosynostosis using posterior vault distraction osteogenesis. Plast Reconstr Surg 137(5):829e–841e. https://doi.org/10.1097/PRS.0000000000002127CrossRefPubMed

Utria AF, Mundinger GS, Bellamy JL et al (2015) The importance of timing in optimizing cranial vault remodeling in syndromic craniosynostosis. Plast Reconstr Surg 135(4):1077–1084. https://doi.org/10.1097/PRS.0000000000001058CrossRefPubMed

Spruijt B, Joosten KFM, Driessen C et al (2015) Algorithm for the management of intracranial hypertension in children with syndromic craniosynostosis. Plast Reconstr Surg 136(2):331–340. https://doi.org/10.1097/PRS.0000000000001434CrossRefPubMed

Raposo-Amaral CE, Denadai R, de Oliveira YM, Ghizoni E, Raposo-Amaral CA (2020) Apert syndrome management: changing treatment algorithm. J Craniofac Surg 31(3):648–652. https://doi.org/10.1097/SCS.0000000000006105CrossRefPubMed

Humphries LS, Swanson JW, Bartlett SP, Taylor JA (2021) Craniosynostosis: posterior cranial vault remodeling. Clin Plast Surg 48(3):455–471. https://doi.org/10.1016/j.cps.2021.03.001CrossRefPubMed

Steinbacher DM, Skirpan J, Puchała J, Bartlett SP (2011) Expansion of the posterior cranial Vault using distraction osteogenesis. Plast Reconstr Surg 127(2):792–801. https://doi.org/10.1097/PRS.0b013e318200ab83CrossRefPubMed

Serlo WS, Ylikontiola LP, Lähdesluoma N et al (2011) Posterior cranial vault distraction osteogenesis in craniosynostosis: estimated increases in intracranial volume. Child Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 27(4):627–633. https://doi.org/10.1007/s00381-010-1353-1CrossRef

Nowinski D, Di Rocco F, Renier D, SainteRose C, Leikola J, Arnaud E (2012) Posterior cranial vault expansion in the treatment of craniosynostosis. Comparison of current techniques. Child Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 28(9):1537–1544. https://doi.org/10.1007/s00381-012-1809-6CrossRef

10.

Choi M, Flores RL, Havlik RJ (2012) Volumetric analysis of anterior versus posterior cranial vault expansion in patients with syndromic craniosynostosis. J Craniofac Surg 23(2):455–458. https://doi.org/10.1097/SCS.0b013e318240ff49CrossRefPubMed

11.

Goldstein JA, Paliga JT, Wink JD, Low DW, Bartlett SP, Taylor JA (2013) A craniometric analysis of posterior cranial vault distraction osteogenesis. Plast Reconstr Surg 131(6):1367–1375. https://doi.org/10.1097/PRS.0b013e31828bd541CrossRefPubMed

12.

Derderian CA, Wink JD, McGrath JL, Collinsworth A, Bartlett SP, Taylor JA (2015) Volumetric changes in cranial vault expansion: comparison of fronto-orbital advancement and posterior cranial vault distraction osteogenesis. Plast Reconstr Surg 135(6):1665–1672. https://doi.org/10.1097/PRS.0000000000001294CrossRefPubMed

13.

Shimizu A, Komuro Y, Shimoji K, Miyajima M, Arai H (2016) Quantitative analysis of change in intracranial volume after posterior cranial vault distraction. J Craniofac Surg 27(5):1135–1138. https://doi.org/10.1097/SCS.0000000000002739CrossRefPubMed

14.

Salokorpi N, Vuollo V, Sinikumpu JJ et al (2017) Increases in cranial volume with posterior cranial vault distraction in 31 consecutive cases. Neurosurgery 81(5):803–811. https://doi.org/10.1093/neuros/nyx125CrossRefPubMed

15.

Bauder AR, Wink JD, Swanson JW, Derderian C, Bartlett SP, Taylor JA (2015) An analysis of posterior vault distraction and its effects on the posterior fossa and cranial base. Plast Reconstr Surg 136:52–53. https://doi.org/10.1097/01.prs.0000472342.36900.c7CrossRef

16.

ter Maaten NS, Mazzaferro DM, Wes AM, Naran S, Bartlett SP, Taylor JA (2018) Craniometric analysis of frontal cranial morphology following posterior Vault distraction. J Craniofac Surg 29(5):1169–1173. https://doi.org/10.1097/SCS.0000000000004473CrossRefPubMed

17.

Samra F, Swanson JW, Mitchell B, Bauder AR, Taylor JA, Bartlett SP (2015) Posterior vault distraction osteogenesis conveys anterior benefit in apert syndrome. Plast Reconstr Surg 136:51. https://doi.org/10.1097/01.prs.0000472340.91157.a7CrossRef

18.

Greives MR, Ware BW, Tian AG, Taylor JA, Pollack IF, Losee JE (2016) Complications in posterior cranial vault distraction. Ann Plast Surg 76(2):211–215. https://doi.org/10.1097/SAP.0000000000000518CrossRefPubMed

19.

Azzolini A, Magoon K, Yang R, Bartlett S, Swanson J, Taylor J (2020) Ventricular shunt complications in patients undergoing posterior vault distraction osteogenesis. Child Nerv Syst 36(5):1009–1016. https://doi.org/10.1007/s00381-019-04403-wCrossRef

20.

Taylor JA, Derderian CA, Bartlett SP, Fiadjoe JE, Sussman EM, Stricker PA (2012) Perioperative morbidity in posterior cranial vault expansion. Plast Reconstr Surg 129(4):674e–680e. https://doi.org/10.1097/PRS.0b013e3182443164CrossRefPubMed

21.

Taylor JA, Bartlett SP (2017) What’s new in syndromic craniosynostosis surgery? Plast Reconstr Surg 140(1):82e–93e. https://doi.org/10.1097/PRS.0000000000003524CrossRefPubMed

22.

Humphries LS, Zapatero ZD, Vu GH et al (2022) Ten years of posterior cranial vault expansion by means of distraction osteogenesis: an update and critical evaluation. Plast Reconstr Surg 150(2):379–391. https://doi.org/10.1097/PRS.0000000000009336CrossRefPubMed

23.

Mazzaferro DM, ter Maaten NS, Wes AM, Naran S, Bartlett SP, Taylor JA (2019) A craniometric analysis of the posterior cranial base after posterior vault distraction. J Craniofac Surg 30(6):1692–1695. https://doi.org/10.1097/SCS.0000000000005496CrossRefPubMed

24.

Kalmar CL, Zapatero ZD, Kosyk MS et al (2022) Transverse distraction osteogenesis for posterior narrowing of the cranial vault. Plast Reconstr Surg 149(4):749e–752e. https://doi.org/10.1097/PRS.0000000000008947CrossRefPubMed

25.

Derderian CA, Bartlett SP (2012) Open cranial vault remodeling: the evolving role of distraction osteogenesis. J Craniofac Surg 23(1):229–234. https://doi.org/10.1097/SCS.0b013e318241b93aCrossRefPubMed

26.

Chen EH, Gilardino MS, Whitaker LA, Bartlett SP (2009) Evaluation of the safety of posterior cranial vault reconstruction. Plast Reconstr Surg 123(3):995–1001. https://doi.org/10.1097/PRS.0b013e318199f4b4CrossRefPubMed

27.

Zapatero ZD, Kalmar CL, Kosyk MS et al (2021) Craniometric and volumetric analysis of posterior vault distraction osteogenesis: 10 year update. J Craniofac Surg 32(7):2379–2383. https://doi.org/10.1097/SCS.0000000000007838CrossRefPubMed

28.

Khechoyan D, Schook C, Birgfeld CB et al (2012) Changes in frontal morphology after single-stage open posterior–middle vault expansion for sagittal craniosynostosis. Plast Reconstr Surg 129(2):504–516. https://doi.org/10.1097/PRS.0b013e31823aec1dCrossRefPubMed

29.

O’Hara J, Way B, Borghi A, Knoops PGM, Chua D, Hayward RD (2019) The turricephaly index: a validated method for recording turricephaly and its natural history in apert syndrome. J Cranio-Maxillofacial Surg 47(3):414–419. https://doi.org/10.1016/j.jcms.2018.12.007CrossRef

30.

Al-Shaqsi S, Ching JA, Novak CB, Forrest CR (2023) Morphometric analysis and outcomes following posterior cranial vault distraction in syndromic and multisuture craniosynostosis. J Plast Reconstr Aesthetic Surg 87:379–386. https://doi.org/10.1016/j.bjps.2023.10.101CrossRef

31.

Arnaud E, Haber SE, Paternoster G et al (2019) Chirurgie secondaire des craniosténoses et faciocraniosténoses. Ann De Chirurgie Plast Esthétique 64(5–6):494–505. https://doi.org/10.1016/j.anplas.2019.07.001CrossRef

32.

Wagner CS, Pontell ME, Hitchner MK et al (2023) Prior fronto-orbital advancement associated with complications from transcranial midface surgery in patients with syndromic craniosynostosis. Child Nerv Syst 39(6):1619–1626. https://doi.org/10.1007/s00381-023-05879-3CrossRef

33.

Renier D, Lajeunie E, Arnaud E, Marchac D (2000) Management of craniosynostoses. Child Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 16(10–11):645–658. https://doi.org/10.1007/s003810000320CrossRef

34.

Wall SA, Goldin JH, Hockley AD, Wake MJC, Poole MD, Briggs M (1994) Fronto-orbital re-operation in craniosynostosis. Br J Plast Surg 47(3):180–184. https://doi.org/10.1016/0007-1226(94)90051-5CrossRefPubMed

35.

Wong GB, Kakulis EG, Mulliken JB (2000) Analysis of fronto-orbital advancement for apert, crouzon, pfeiffer, and saethre-chotzen syndromes. Plast Reconstr Surg 105(7):2314–2323. https://doi.org/10.1097/00006534-200006000-00002CrossRefPubMed

36.

McCarthy JG, Glasberg SB, Cutting CB et al (1995) Twenty-year experience with early surgery for craniosynostosis: II. The craniofacial synostosis syndromes and pansynostosis–results and unsolved problems. Plast Reconstr Surg 96(2):284–295 discussion 296-8CrossRefPubMed

37.

Spruijt B, Rijken BFM, den Ottelander BK et al (2016) First vault expansion in apert and crouzon-pfeiffer syndromes. Plast Reconstr Surg 137(1):112e–121e. https://doi.org/10.1097/PRS.0000000000001894CrossRefPubMed

38.

Muenke M, Gripp KW, McDonald-McGinn DM et al (1997) A unique point mutation in the fibroblast growth factor receptor 3 gene (FGFR3) defines a new craniosynostosis syndrome. Am J Hum Genet 60(3):555–564PubMedPubMedCentral

39.

Choi TM, Lijten OW, Mathijssen IMJ, Wolvius EB, Ongkosuwito EM (2022) Craniofacial morphology and growth in muenke syndrome, saethre-chotzen syndrome, and TCF12-related craniosynostosis. Clin Oral Invest 26(3):2927–2936. https://doi.org/10.1007/s00784-021-04275-yCrossRef

40.

den Ottelander BK, de Goederen R, van Veelen MLC et al (2019) Muenke syndrome: long-term outcome of a syndrome-specific treatment protocol. J Neurosurgery: Pediatr 24(4):415–422. https://doi.org/10.3171/2019.5.PEDS1969CrossRef

41.

Den Ottelander BK, Van Veelen MC, De Goederen R et al (2021) Saethre–Chotzen syndrome: long-term outcome of a syndrome‐specific management protocol. Dev Med Child Neurol 63(1):104–110. https://doi.org/10.1111/dmcn.14670CrossRefPubMed

42.

Marucci DD, Dunaway DJ, Jones BM, Hayward RD (2008) Raised intracranial pressure in apert syndrome. Plast Reconstr Surg 122(4):1162–1168. https://doi.org/10.1097/PRS.0b013e31818458f0CrossRefPubMed

43.

Johns D, Anstadt E, Donato D et al (2016) Early posterior vault distraction osteogenesis for the treatment of syndromic craniosynostosis. CraniomaxTrauma Reconstr 9(3):219–223. https://doi.org/10.1055/s-0036-1582455CrossRef

Title: Early posterior vault distraction osteogenesis changes the syndromic craniosynostosis treatment paradigm: long-term outcomes of a 23-year cohort study
Authors: Meagan Wu
Sarah L. Barnett
Benjamin B. Massenburg
Jinggang J. Ng
Dominic J. Romeo
Jesse A. Taylor
Scott P. Bartlett
Jordan W. Swanson
Publication date: 21-06-2024
Publisher: Springer Berlin Heidelberg
Keyword: Craniosynostosis
Published in: Child's Nervous System / Issue 9/2024
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-024-06465-x

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Early posterior vault distraction osteogenesis changes the syndromic craniosynostosis treatment paradigm: long-term outcomes of a 23-year cohort study

Abstract

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