{"id":"4ba58237-c06f-4af5-9518-2e0eeb7741ba","slug":"results-and-limits-of-posterior-cranial-vault-expansion-by-osteotomy-and-internal-distractors","title":"Results and limits of posterior cranial vault expansion by osteotomy and internal distractors","authors":["Federico Di Rocco","Kenichi Usami","Tatiana Protzenko","Corinne Collet","Kim Giraudat","Eric Arnaud"],"abstract":"Background: Expanding the posterior cranial vault has become a common procedure in the treatment of complex craniosynostosis. Several techniques are available to remodel the posterior vault. Aim of this study was to analyze the posterior vault distraction osteogenesis. Methods: Between 2011 and 2014, 21 children (12 boys) were operated on for a posterior distraction of the cranial vault. The mean age was 8.6 months (minimum, 3 months; maximum, 15 years). Thirteen patients presented a craniofacial syndrome. Five had already been operated on (two anterior cranial surgery, two suboccipital decompression, and one craniotomy for sagittal synostosis). Raised intracranial pressure (ICP) was present in 6 patients. Seven patients had symptomatic cerebellar tonsils herniation (TH). Results: In 17 children, 2 lateral distractors were placed, in 3 a 3rd medial distractor was placed, and in 1 child 4 distractors were implanted. Volumetric analysis based on computed tomography showed a mean increase of volume of 13.9% 117 days later. After the distraction, symptoms related to raised ICP or TH were improved in all patients, however, radiologically TH was improved at the last follow-up in 54% of the cases. Conclusion: Posterior cranial vault distraction is an efficacious technique to enlarge the posterior skull vault and treat increased ICP. Moreover, it appears to be efficacious in treating TH-related symptoms.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/4ba58237-c06f-4af5-9518-2e0eeb7741ba/featured/hero-1782420850271.png","publishDate":"2018-10-30T00:00:00.000Z","doi":"10.4103/sni.sni_465_17","categories":["Pediatric Neurosurgery","Original Article"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2018/11/9052/SNI-9-217.pdf"}