Udayakumaran Suhas, P V Vinanthi, Subash Pramod, Nerurkar Shibani, Krishnadas Arjun, Aggarwal Ambuj, Xavier Sarin
Division of Paediatric Neurosurgery and Craniofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi - 41, Kerala, India.
Department of Cranio-Maxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi - 41, Kochi - 41, India.
Childs Nerv Syst. 2025 Apr 10;41(1):153. doi: 10.1007/s00381-025-06816-2.
To evaluate indications, techniques, nuances, and outcomes of posterior cranial vault distraction (PCVD) in children with craniosynostoses.
We performed clinical assessments, multidimensional CT, MRI brain rapid protocol, ophthalmological evaluation, sleep study, and nasal endoscopy (if indicated). Detailed data was collected in Excel. Customized craniotomy (supratorcular or subtorcular), distraction vectors, strategic barrel staving on stenosed bones (other than lambdoid), and ~ 2 cm relief craniectomy for venous decompression were employed. Additional procedures were performed for the frontal and midface aspects during distractor removal based on functional needs.
Thirty-seven patients (ages 4-204 months, mean 32.94 months) underwent PCVD. Supratorcular PCVD in 8, subtorcular in 29. The distraction vector was posterior-horizontal in 28 cases and posterior-inferior in 9. Strategic barrel staving was used in 8 cases, and venous decompression in 24. Initial assessments showed satisfactory clinical and radiological outcomes. Long-term follow-up indicated seven of 11 patients with hydrocephalus required a ventriculoperitoneal shunt, and two needed additional PCVD procedures due to symptom recurrence. Average intracranial volume increased by 186 ± 42.67 cm (18 patients), and the average distraction achieved was 21 ± 2.64 mm (37 patients). Additional procedures at the time of distractor removal included fronto-facial or monobloc advancement (n = 3), isolated fronto-orbital advancement and remodeling (n = 13), and midface distraction for airway issues (monobloc advancement, n = 3; isolated midface, n = 9). Nine patients underwent all three procedures in sequence.
PCVD is an accepted surgical strategy for craniosynostosis with posterior calvarial involvement. Our technical modifications aim to enhance functional and aesthetic outcomes without increasing morbidity.
评估儿童颅缝早闭患者后颅穹窿牵张术（PCVD）的适应症、技术、细微差别及疗效。
我们进行了临床评估、多维CT、脑部MRI快速成像、眼科评估、睡眠研究以及鼻内镜检查（如有需要）。详细数据收集于Excel中。采用定制开颅术（眶上或窦下）、牵张向量、对狭窄骨（除人字缝外）进行策略性桶状扩张以及约2cm减压颅骨切除术以进行静脉减压。在去除牵张器时，根据功能需求对额部和中面部进行额外手术。
37例患者（年龄4 - 204个月，平均32.94个月）接受了PCVD。眶上PCVD 8例，窦下PCVD 29例。牵张向量为后水平方向28例，后下方向9例。8例采用策略性桶状扩张，24例进行静脉减压。初始评估显示临床和影像学结果满意。长期随访表明，11例脑积水患者中有7例需要脑室腹腔分流术，2例因症状复发需要额外的PCVD手术。18例患者的平均颅内体积增加了186±42.67cm，37例患者的平均牵张量为21±2.64mm。去除牵张器时的额外手术包括额面或整块前移（n = 3）、孤立的额眶前移和重塑（n = 13）以及因气道问题进行的中面部牵张（整块前移，n = 3；孤立中面部，n = 9）。9例患者依次接受了所有三种手术。
PCVD是治疗累及后颅盖的颅缝早闭的一种可接受的手术策略。我们的技术改进旨在提高功能和美学效果，同时不增加发病率。
