Novel Approach to Total Frontal Bone Loss After Surgery for Craniosynostosis - The Modified Visor Bone Flap with Brain Cage
Valenti, Alyssa, MD1, Asadourian, Paul MEng2, Truong, Albert, MD1, Souweidane, Mark, MD1, Imahiyerobo Thomas, MD, FAAP, FACS1
1New York Presbyterian Hospital, Cornell and Columbia, New York, New York; 2Columbia University College of Physicians and Surgeons, New York, New York
BACKGROUND: Complications after surgery for craniosynostosis are estimated to occur in between 11 and 36% (1,2). Though uncommon, complications such as infection, osteomyelitis, and bone loss can result in challenging scenarios for the craniofacial surgeon to reconstruct. Specifically, in young patients where alloplastic reconstruction is suboptimal, novel solutions to address significant bone loss after failed cranial vault repair are needed. Successful reconstruction of these complex cases is necessary to avoid potential devastating consequences associated with this complication.
METHODS: In this case study, a novel surgical approach using Virtual Surgical Planning (VSP) is discussed to address total bi-frontal bone loss due to infection in an 18 month old female after initial cranial vault reconstruction with frontal orbital advancement for right coronal craniosynostosis at an outside hospital. A treatment algorithm for this clinical entity is proposed.
RESULTS: Using VSP, a Modified Visor Bone Flap with Posterior Brain Cage was performed; the patient underwent posterior cranial vault remodeling with a construct fashioned from available cranial bone struts to obtain widespread coverage over the parietal-occipital bone area. VSP was utilized to determine the most efficient construct configuration possible to achieve maximal coverage. The occipital bone was then remodeled to replace her missing frontal bone bilaterally. In this fashion, both the posterior and anterior vaults were remodeled to address significant frontal bone loss. The patient had a successful result.
CONCLUSIONS: Given the successful result of this case, we propose a novel treatment algorithm to address total frontal bone loss in patients after failed surgery for craniosynostosis. References: Lee HQ, Hutson JM, Wray AC, et al. Analysis of morbidity and mortality in surgical management of craniosynostosis. J Craniofac Surg. 2012;23(5):1256-1261. doi:10.1097/SCS.0b013e31824e26d6 Shastin D, Peacock S, Guruswamy V, et al. A proposal for a new classification of complications in craniosynostosis surgery. J Neurosurg Pediatr. 2017;19(6):675-683. doi:10.3171/2017.1.PEDS16343
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