Sunday, October 10, 2004

Distraction Osteogenesis for Early Correction of Sagittal Craniosynostosis

Eun Soo Park, MD and Yong Bae Kim, MD.

When Sagittal synostosis is associated with functional complications like elevated ICP, hydrocephalus, mental retardation, visual abnormalities, and multiple suture synostosis, surgical correction is imperative. But, craniofacial surgery can be risky when it comes to an infant or a small child because the blood volume in these patients is small and a minor hemorrhage may cause proportionately greater blood loss, resulting in a great stress on the patients. Mortality is not usually resulted from craniofacial surgery, but it is mostly from operative hemorrhage and infections. Releasing the stenosis and reshaping the cranial vault are the primary operative goals. Authors tried to minimize surgical stress on children and attain control of cranial vault reshaping by gradual distraction osteogenesis in treating children with sagittal suture synostosis. Three sagittal synostosis patients aged from 11 months to 3 years old were treated. One of the patients had multiple suture synostosis. Patient follow-up ranged from 6 months to 3 years. Biparietal bone flap was elevated and external distraction devices were inserted. Distraction rate varied from 0.5 to 1mm/day, without a latency period. After a consolidation period of 2-3weeks, the devices were removed. Functional disabilities such as elevated ICP and mental retardation decreased significantly after surgery. Radiological follow-up showed cessation of enhancement of bone deposition at the frontal and occipital sutures. Excellent aesthetic results were shown in all the three patients. Application of distraction osteogenesis in correcting sagittal craniosynostosis is very effective; It can decrease stress on patients and make controlled cranial vault reshaping possible.
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