Highlighting posterior cranial vault expansion remodeling for treating various types of craniosynostosis in children.

Abstract

Objective: To evaluate the efficacy of posterior cranial vault expansion remodeling (PCVR) in treating various types of craniosynostosis in children.

Methods: We retrospectively analyzed clinical data from seven patients with diverse craniosynostosis types who underwent posterior cranial vault expansion remodeling as the main surgical operation between February 2018 and September 2023. The cohort included five boys and two girls, aged 10 to 23 months. Preoperative three-dimensional computed tomography (3D-CT) scans were assessed. The sample comprised one case each of sagittal, unilambdoid, bilambdoid, bicoronal craniosynostosis, Pfeiffer syndrome, Crouzon syndrome, and combined sagittal and unilambdoid craniosynostosis. Two patients with Chiari malformation (CM) (type I) required additional foramen magnum decompression. Patients with bicoronal craniosynostosis and Pfeiffer syndrome underwent subsequent frontal-orbital advancement and remodeling.

Results: No fatalities, sinus injuries, cerebrospinal fluid leaks, or infections of the skull and scalp occurred. The mean follow-up duration was 16.6 months (range: 7-42 months). All patients exhibited significant improvements in skull deformities. Volumetric analysis 1 week post-surgery indicated an increase in cranial volume from 45 to 94 cm³, with a mean increase of 69.6 cm³. The cranial cavity volume increased by an average of approximately 92.43 cm³ from preoperative levels at the 3-month postoperative follow-up (range from 61 to 115 cm³).

Conclusions: Posterior cranial vault expansion remodeling proves to be an effective treatment for syndromic craniosynostosis and lambdoid craniosynostosis. It is also beneficial for treating sagittal and other craniosynostosis associated with deformities of the posterior cranial fossa.