Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Childs Nerv Syst. 2021 Oct;37(10):3119-3125. doi: 10.1007/s00381-021-05118-7. Epub 2021 Mar 20.
Cranial vault remodeling (CVR) in patients with craniosynostosis serves to correct abnormal skull morphology and increase intracranial volume to prevent or treat pathologic increases in intracranial pressure (Taylor and Bartlett, Plast Reconstr Surg 140: 82e-93e, 2017). Distraction osteogenesis is a well-established technique for bony repositioning and growth stimulation in the facial and long bones, in which the gradual separation of bony segments at an osteotomy site results in generation of new bone and subsequent bone lengthening (Greene, 2018). While initially described in the orthopedic literature, the relevance and applicability of distraction osteogenesis to craniofacial surgery has been well-studied and is now well-established (Steinbacher et al., Plast Reconstr Surg 127: 792-801, 2011). Posterior cranial vault distraction osteogenesis (PVDO) was introduced as a treatment option for cranial vault expansion in patients with craniosynostosis in 2009 by White et al., based upon the premise that posterior vault distraction could provide greater intracranial volume expansion than fronto-orbital advancement and remodeling (FOAR), but that acute posterior cranial vault expansions were limited by the soft tissue envelope of the infant scalp and prone to relapse related to the supine positioning typical of infants (White et al., Childs Nerv Syst 25: 231-236, 2009). Since this introduction, significant evidence has accrued regarding the safety of, and outcomes after, PVDO. PVDO is now known to provide larger increases in intracranial volume in comparison to anterior cranial vault remodeling procedures (Derderian et al., Plast Reconstr Surg 135:1665-1672, 2015) and to provide morphologic improvements in both the posterior and anterior cranial vaults (Goldstein et al., Plast Reconstr Surg 131:1367-1375, 2013). Perioperative major morbidity is comparable to conventional vault remodeling (Taylor et al., Plast Reconstr Surg 129:674e-680e, 2012) and the procedure has been safely applied to patients of various ages with syndromic and non-syndromic craniosynostosis (Zhang et al., J Craniofac Surg 29:566-571, 2018; Li et al., J Craniofac Surg 27:1165-1169, 2016). Many high-volume craniofacial centers now consider PVDO the preferred first operation in infants with syndromic craniosynostosis, and indications for this procedure continue to expand as evidence accrues regarding its utility and safety (Steinbacher et al., Plast Reconstr Surg 127: 792-801, 2011; Swanson et al., Plast Reconstr Surg 137:829e-841e, 2016).
颅骨穹窿重建（Cranial Vault Remodeling，CVR）在颅缝早闭患者中用于矫正异常颅骨形态和增加颅内体积，以预防或治疗颅内压病理性增高（Taylor 和 Bartlett，Plast Reconstr Surg 140：82e-93e，2017）。牵张成骨术是一种成熟的技术，用于面部和长骨的骨重定位和生长刺激，在该技术中，骨切开部位的骨段逐渐分离，导致新骨生成和随后的骨延长（Greene，2018）。虽然最初在矫形文献中描述，但牵张成骨术与颅面外科的相关性和适用性已得到充分研究，现已得到充分确立（Steinbacher 等人，Plast Reconstr Surg 127：792-801，2011）。2009 年，White 等人将后颅穹窿牵张术（Posterior Cranial Vault Distraction Osteogenesis，PVDO）作为颅缝早闭患者颅穹窿扩张的治疗选择引入，其前提是后颅穹窿牵张术可以比额眶成形术和重塑术（Fronto-Orbital Advancement and Remodeling，FOAR）提供更大的颅内体积扩张，但急性后颅穹窿扩张受到婴儿头皮软组织包膜的限制，并且容易因婴儿典型的仰卧位而复发（White 等人，Childs Nerv Syst 25：231-236，2009）。自该技术引入以来，关于 PVDO 的安全性和术后结果的证据不断增加。现已证实，PVDO 与前颅穹窿重塑术相比，可使颅内体积增加更大（Derderian 等人，Plast Reconstr Surg 135：1665-1672，2015），并在后颅穹窿和前颅穹窿均改善形态（Goldstein 等人，Plast Reconstr Surg 131：1367-1375，2013）。围手术期主要并发症与传统的穹窿重塑术相当（Taylor 等人，Plast Reconstr Surg 129：674e-680e，2012），并且该手术已安全应用于各种年龄的伴有综合征和非综合征性颅缝早闭的患者（Zhang 等人，J Craniofac Surg 29：566-571，2018；Li 等人，J Craniofac Surg 27：1165-1169，2016）。许多颅面外科中心现在认为 PVDO 是综合征性颅缝早闭婴儿的首选初次手术，并且随着关于其效用和安全性的证据不断增加，该手术的适应证也在不断扩大（Steinbacher 等人，Plast Reconstr Surg 127：792-801，2011；Swanson 等人，Plast Reconstr Surg 137：829e-841e，2016）。
