Repeat posterior cranial vault distraction osteogenesis: indications and modification of technique
Ian Hoppe, MD, Rosaline Zhang, Lawrence Lin, Anthony G. Azzolini, MD, Jordan W. Swanson, MD, Scott P. Bartlett, MD, Jesse A. Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Background: As posterior cranial vault distraction osteogenesis (PVDO) becomes more widely utilized to treat craniosynostosis, there are potential circumstances in which a second, or repeat, PVDO may be indicated. The purpose of this paper is to discuss the authors' experience with repeat PVDO, examining the indications for this procedure and technical aspects that may be utilized to obtain an optimal outcome.
Methods: Patients undergoing PVDO between 2009-2018 at the Children's Hospital of Philadelphia were reviewed, and those who underwent repeat PVDO were selected. Indications, operative details, and peri-operative outcomes for this subset of patients were examined.
Results: Of the 89 patients who underwent PVDO during the study period, six were repeat PVDO's. The most common indication for secondary PVDO was concern for increased intracranial pressure (50%). Other indications for secondary PVDO were residual turribrachycephaly (33%) and large transosseus veins identified at the initial surgery that were unable to be ligated (16%). The most common method for secondary PVDO was a traditional PVDO (67%), as previously described by our authors. One of the six had a traditional PVDO with but a wire "hinge" placed at the superiormost aspect of the transport segment to allow for preferential inferior expansion. Finally, one of the six utilized transverse distraction due to relatively normal head shape.
Conclusion: As PVDO grows in popularity in treating complex craniosynostosis, there are times when repeat PVDO may be indicated. This study highlights some of those indications and addresses nuances in PVDO's implementation.
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