The Use of Intraoperative Radiography for Osteotomy Planning in Craniosynostosis Posterior Cranial Vault Distractor Application, Technique Description

Taghreed Alhumsi, MD, SB-plast, EBOPRAS; Abdulaziz Alshenaifi, MD; Mohammed Almarghoub, MD

Disclosures

ePlasty. 2020;20(e8) 

In This Article

Abstract and Introduction

Abstract

Posterior cranial vault distraction osteogenesis (PVDO) is evolving as one of the first-line treatments in managing craniosynostosis. Intraoperative decision for sites of osteotomies requires precise planning and accurate placement of distractors. Objective: This technique helps in determining and confirming the pre-surgical planned osteotomy sites along with the distraction vectors. Technique: intraoperative plain skull radiography is used to determine the osteotomy site guiding placement of distractors using radio-opaque instrument. Result and discussion: we believe this technique helps translate the planned osteotomy sites and distraction vectors accurately to the skull and minimizes intra-operative error which will subsequently improve outcomes. Conclusion: This technique is a quick and safe tool for proper placement of posterior cranial vault distractor. However, further comparative studies are needed in addition to measuring cost, time added to the procedure, and radiation exposure.

Introduction

Posterior cranial vault distraction osteogenesis (PVDO) is one of the options used to manage children with craniosynostosis. It is evolving as one of the first-line treatments in managing craniosynostosis with increased intracranial pressure.[1] In addition, PVDO is believed to result in a greater increase in cranial volume than in fronto-orbital advancement.[2] Multiple methods of distraction have been described, including single vector, multiple vectors, and spring-assisted distraction,[3,4] all of which need thorough clinical and radiological presurgical planning to ascertain the best outcome.[5] It has been noticed that intraoperative decision for the sites of osteotomy has been correlated with preoperative computed tomographic (CT) scans. We believe that the intraoperative calvarial dimension could be different from that predicted by CT scans, especially if the scans were dated much earlier than the surgical date. There are cases where it is difficult to correlate the CT scan to the intraoperative situation as planned preoperatively. Therefore, we suggest the use of intraoperative skull radiography as an available and straightforward technique that helps in determining and confirming the presurgical planned osteotomy sites along with the distraction vectors.

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