J Korean Neurosurg Soc.  2016 May;59(3):233-241. 10.3340/jkns.2016.59.3.233.

Distraction Osteogenesis Update: Introduction of Multidirectional Cranial Distraction Osteogenesis

• Gomi A
• Sunaga A
• Kamochi H
• Oguma H
• Sugawara Y

• KMID: 2192095
• DOI: http://doi.org/10.3340/jkns.2016.59.3.233

Abstract

In this review, we discuss in detail our current procedure for treating craniosynostosis using multidirectional cranial distraction osteogenesis (MCDO). The MCDO method allows all phenotypes of skull deformity to be reshaped by distraction osteogenesis, except in patients who are 5 months of age or younger and patients with posterior cranial vault problems. We report the results of clinical data of 36 children with craniosynostosis who underwent MCDO between 2005 and 2014 in our institute. This method has the following benefits, such as a high flexibility of reshaping, shorter treatment period and less invasive secondary intervention. We also discuss the other distraction osteogenesis techniques that are used to treat craniosynostosis and compare them with MCDO. The preferred procedure for correction of craniosynostosis may depend on the patient's age, the extent of deformity, and the extent of correction achievable by surgery. We can arrange the combinations of various methods according to the advantage and disadvantage of each technique.

Keyword

Craniosynostosis; Distraction osteogenesis; Multidirectional cranial distraction osteogenesis; Posterior cranial vault distraction osteogenesis

MeSH Terms

Child
Congenital Abnormalities
Craniosynostoses
Humans
Osteogenesis, Distraction*
Phenotype
Pliability
Skull

Figure

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  Fig. 1 Multidirectional cranial distraction osteogenesis (MCDO) procedure. A : Zigzag coronal incision. B : Designing the lines of osteotomy and the drilling points. C : Attachment of the template for anchor pins. D : Drilling the screw holes for anchor pins. E : Osteotomy in small rectangular pieces with an ultrasonic bone curette. F : Rectangular pieces without dural dissection. G : Fixation of traction pins. H : The heads of the traction pins and anchor pins penetrating the scalp. I : Screw of the anchor pins. J : Fixation of the frame on the anchor pins. K : The wires passing through holes in the frame. L : Fixation of the wires to the distractors.

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  Fig. 2 After completion of the distraction, all distractors were removed, and the ends of the wires were tied onto the plastic rings to prevent loosening.

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  Fig. 3 A case of sagittal synostosis in a 7-month-old boy. A : Photograph of the patient before surgery. B : Photograph at the surgery. Bioresorbable plates were used in this patient as base stones to strengthen the stability of anchor pins and traction pins. C : Wearing the MCDO-T frame. D : Photograph of the patient at 12 months after surgery. E, F, and G : Three-dimensional CT findings before surgery. H, I, and J : Three-dimensional CT findings at 12 months after surgery. This patient underwent 9 days of activation and 35 days of consolidation.

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  Fig. 4 We calculated the expansion volume by a rough simulation. Because an infant skull resembles a sphere, the volume of the upper anterior quarter of the skull can be calculated using the formula shown in this figure. A quarter volume of a sphere with a radius of r cm before surgery is VA. VB and VC are the volume after the MCDO procedure and unidirectional frontal distraction surgery, respectively.

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