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

Affiliations
  • 1Department of Pediatric Neurosurgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, Tochigi, Japan. gomi@jichi.ac.jp
  • 2Department of Plastic Surgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, Tochigi, Japan.

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

  • 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.

  • 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.

  • 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.

  • 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.


Reference

1. Akai T, Iizuka H, Kawakami S. Treatment of craniosynostosis by distraction osteogenesis. Pediatr Neurosurg. 2006; 42:288–292. PMID: 16902340.
Article
2. Akai T, Shiraga S, Sasagawa Y, Iizuka H, Yamashita M, Kawakami S. Troubleshooting distraction osteogenesis for craniosynostosis. Pediatr Neurosurg. 2013; 49:380–383. PMID: 25500456.
Article
3. Cho BC, Hwang SK, Uhm KI. Distraction osteogenesis of the cranial vault for the treatment of craniofacial synostosis. J Craniofac Surg. 2004; 15:135–144. PMID: 14704580.
Article
4. Choi JW, Ra YS, Hong SH, Kim H, Shin HW, Chung IW, et al. Use of distraction osteogenesis to change endocranial morphology in unilateral coronal craniosynostosis patients. Plast Reconstr Surg. 2010; 126:995–1004. PMID: 20811231.
Article
5. David LR, Proffer P, Hurst WJ, Glazier S, Argenta LC. Spring-mediated cranial reshaping for craniosynostosis. J Craniofac Surg. 2004; 15:810–816. discussion 817-818. PMID: 15346023.
Article
6. Derderian CA, Bartlett SP. Open cranial vault remodeling : the evolving role of distraction osteogenesis. J Craniofac Surg. 2012; 23:229–234. PMID: 22337415.
7. Derderian CA, Bastidas N, Bartlett SP. Posterior cranial vault expansion using distraction osteogenesis. Childs Nerv Syst. 2012; 28:1551–1556. PMID: 22872272.
Article
8. Derderian CA, Wink JD, McGrath JL, Collinsworth A, Bartlett SP, Taylor JA. Volumetric changes in cranial vault expansion : comparison of fronto-orbital advancement and posterior cranial vault distraction osteogenesis. Plast Reconstr Surg. 2015; 135:1665–1672. PMID: 25724062.
9. Esparza J, Hinojosa J. Complications in the surgical treatment of craniosynostosis and craniofacial syndromes : apropos of 306 transcranial procedures. Childs Nerv Syst. 2008; 24:1421–1430. PMID: 18769932.
Article
10. Governale LS. Craniosynostosis. Pediatr Neurol. 2015; 53:394–401. PMID: 26371995.
Article
11. Hirabayashi S, Sugawara Y, Sakurai A, Harii K, Park S. Frontoorbital advancement by gradual distraction. Technical note. J Neurosurg. 1998; 89:1058–1061. PMID: 9833840.
12. Imai K, Komune H, Toda C, Nomachi T, Enoki E, Sakamoto H, et al. Cranial remodeling to treat craniosynostosis by gradual distraction using a new device. J Neurosurg. 2002; 96:654–659. PMID: 11990803.
Article
13. Jimenez DF, Barone CM. Early treatment of coronal synostosis with endoscopy-assisted craniectomy and postoperative cranial orthosis therapy : 16-year experience. J Neurosurg Pediatr. 2013; 12:207–219. PMID: 23808724.
Article
14. Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998; 88:77–81. PMID: 9420076.
Article
15. Jimenez DF, Barone CM, Cartwright CC, Baker L. Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy. Pediatrics. 2002; 110(1 Pt 1):97–104. PMID: 12093953.
Article
16. Katsuragi YT, Gomi A, Sunaga A, Miyazaki K, Kamochi H, Arai F, et al. Intracerebral foreign body granuloma caused by a resorbable plate with passive intraosseous translocation after cranioplasty. J Neurosurg Pediatr. 2013; 12:622–625. PMID: 24093591.
Article
17. Kim SW, Shim KW, Plesnila N, Kim YO, Choi JU, Kim DS. Distraction vs remodeling surgery for craniosynostosis. Childs Nerv Syst. 2007; 23:201–206. PMID: 17053939.
Article
18. Komuro Y, Shimizu A, Shimoji K, Miyajima M, Arai H. Posterior cranial vault distraction osteogenesis with barrel stave osteotomy in the treatment of craniosynostosis. Neurol Med Chir (Tokyo). 2015; 55:617–623. PMID: 26226978.
Article
19. Komuro Y, Shimizu A, Ueda A, Miyajima M, Nakanishi H, Arai H. Whole cranial vault expansion by continual occipital and fronto-orbital distraction in syndromic craniosynostosis. J Craniofac Surg. 2011; 22:269–272. PMID: 21233733.
Article
20. Komuro Y, Yanai A, Hayashi A, Miyajima M, Nakanishi H, Arai H. Treatment of unilateral lambdoid synostosis with cranial distraction. J Craniofac Surg. 2004; 15:609–613. PMID: 15213539.
Article
21. Lauritzen CG, Davis C, Ivarsson A, Sanger C, Hewitt TD. The evolving role of springs in craniofacial surgery : the first 100 clinical cases. Plast Reconstr Surg. 2008; 121:545–554. PMID: 18300975.
Article
22. Lee JA, Park DH, Yoon SH, Chung J. Distractor breakage in cranial distraction osteogenesis for children with craniosynostosis. Pediatr Neurosurg. 2008; 44:216–220. PMID: 18354261.
Article
23. Lee MC, Shim KW, Park EK, Yun IS, Kim DS, Kim YO. Expansion and compression distraction osteogenesis based on volumetric and neurodevelopmental analysis in sagittal craniosynostosis. Childs Nerv Syst. 2015; 31:2081–2089. PMID: 26231567.
Article
24. McCarthy JG, Schreiber J, Karp N, Thorne CH, Grayson BH. Lengthening the human mandible by gradual distraction. Plast Reconstr Surg. 1992; 89:1–8. discussion 9-10. PMID: 1727238.
Article
25. Nishimoto S, Oyama T, Nagashima T, Shimizu F, Tsugawa T, Takeda M, et al. Gradual distraction fronto-orbital advancement with 'floating forehead' for patients with syndromic craniosynostosis. J Craniofac Surg. 2006; 17:497–505. PMID: 16770188.
Article
26. Nonaka Y, Oi S, Miyawaki T, Shinoda A, Kurihara K. Indication for and surgical outcomes of the distraction method in various types of craniosynostosis. Advantages, disadvantages, and current concepts for surgical strategy in the treatment of craniosynostosis. Childs Nerv Syst. 2004; 20:702–709. PMID: 15168051.
27. Nowinski D, Di Rocco F, Renier D, SainteRose C, Leikola J, Arnaud E. Posterior cranial vault expansion in the treatment of craniosynostosis. Comparison of current techniques. Childs Nerv Syst. 2012; 28:1537–1544. PMID: 22872270.
Article
28. Nowinski D, Saiepour D, Leikola J, Messo E, Nilsson P, Enblad P. Posterior cranial vault expansion performed with rapid distraction and time-reduced consolidation in infants with syndromic craniosynostosis. Childs Nerv Syst. 2011; 27:1999–2003. PMID: 21863295.
Article
29. Ong J, Harshbarger RJ 3rd, Kelley P, George T. Posterior cranial vault distraction osteogenesis : evolution of technique. Semin Plast Surg. 2014; 28:163–178. PMID: 25383052.
Article
30. Park DH, Chung J, Yoon SH. Rotating distraction osteogenesis in 23 cases of craniosynostosis : comparison with the classical method of craniotomy and remodeling. Pediatr Neurosurg. 2010; 46:89–100. PMID: 20664235.
Article
31. Park DH, Yoon SH. Transsutural distraction osteogenesis for 285 children with craniosynostosis : a single-institution experience. J Neurosurg Pediatr. 2015; 18:1–10. PMID: 26382181.
32. Serlo WS, Ylikontiola LP, Lähdesluoma N, Lappalainen OP, Korpi J, Verkasalo J, et al. Posterior cranial vault distraction osteogenesis in craniosynostosis : estimated increases in intracranial volume. Childs Nerv Syst. 2011; 27:627–633. PMID: 21125285.
Article
33. Sgouros S, Goldin JH, Hockley AD, Wake MJ. Posterior skull surgery in craniosynostosis. Childs Nerv Syst. 1996; 12:727–733. PMID: 9118138.
Article
34. Steinbacher DM, Skirpan J, Puchała J, Bartlett SP. Expansion of the posterior cranial vault using distraction osteogenesis. Plast Reconstr Surg. 2011; 127:792–801. PMID: 21285783.
Article
35. Sugawara Y, Hirabayashi S, Sakurai A, Harii K. Gradual cranial vault expansion for the treatment of craniofacial synostosis : a preliminary report. Ann Plast Surg. 1998; 40:554–565. PMID: 9600446.
Article
36. Sugawara Y, Uda H, Sarukawa S, Sunaga A. Multidirectional cranial distraction osteogenesis for the treatment of craniosynostosis. Plast Reconstr Surg. 2010; 126:1691–1698. PMID: 21042126.
Article
37. Tahiri Y, Swanson JW, Taylor JA. Distraction osteogenesis versus conventional fronto-orbital advancement for the treatment of unilateral coronal synostosis : a comparison of perioperative morbidity and short-term outcomes. J Craniofac Surg. 2015; 26:1904–1908. PMID: 26335320.
Article
38. Thomas GP, Wall SA, Jayamohan J, Magdum SA, Richards PG, Wiberg A, et al. Lessons learned in posterior cranial vault distraction. J Craniofac Surg. 2014; 25:1721–1727. PMID: 25162545.
Article
39. White N, Evans M, Dover MS, Noons P, Solanki G, Nishikawa H. Posterior calvarial vault expansion using distraction osteogenesis. Childs Nerv Syst. 2009; 25:231–236. PMID: 19057909.
Article
40. Wiberg A, Magdum S, Richards PG, Jayamohan J, Wall SA, Johnson D. Posterior calvarial distraction in craniosynostosis - an evolving technique. J Craniomaxillofac Surg. 2012; 40:799–806. PMID: 22560871.
Article
41. Winston KR, Ketch LL, Dowlati D. Cranial vault expansion by distraction osteogenesis. J Neurosurg Pediatr. 2011; 7:351–361. PMID: 21456905.
Article
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