Case Report

Pan-suture Synostosis After Posterior Vault Distraction

Katrina F. Chu, BA; Stephen R. Sullivan, MD, MPH; Helena O. Taylor, MD, PhD

Disclosures

ePlasty. 2013;13 

In This Article

Abstract and Introduction

Abstract

Objective: Posterior vault remodeling by distraction osteogenesis is a relatively new technique used for initial correction of turribrachycephaly in children with bicoronal craniosynostosis. We present a new potential complication from this procedure; a case of pan-suture synostosis subsequent to posterior vault distraction.

Methods: We report an infant girl who presented with bicoronal synostosis in the setting of Saethre-Chotzen syndrome. She underwent posterior vault distraction and was distracted a total of 34 millimeters, with successful osteogenesis at the site.

Results: One year postoperatively, the patient was found to have incidental, asymptomatic pan-suture synostosis on computed tomography.

Conclusions: To our knowledge, this is the first reported case of delayed craniosynostosis after posterior vault distraction in the literature. The possible pathogenesis and significance of this case are discussed with a review of the current literature.

Introduction

Surgical correction is advocated for both idiopathic and syndromic craniosynostosis to expand the cranial vault, relieve elevated intracranial pressure, prevent constriction of the synostotic skull on the developing brain, and correct cranial morphology. Posterior vault remodeling via distraction osteogenesis is increasingly used for the initial correction of turribrachycephaly[1–4] in children with bicoronal synostosis, in which calvarial growth is limited in the anterior-posterior plane, and compensation occurs in the cranial-caudal direction. The relative benefit of posterior vault distraction over conventional cranial remodeling is controversial.[1,4]

Described complications of vault distraction include infection, hematoma, dural or cerebral spinal fluid leaks, and hardware complications.[5] We present a new potential complication from this procedure; a case of pan-suture synostosis subsequent to posterior vault distraction. The possible pathogenesis and significance of this case are discussed with a review of the current literature.

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