Troubleshooting Distraction Osteogenesis for Craniosynostosis

被引:7
作者
Akai, Takuya [1 ]
Shiraga, Syunsuke [1 ]
Sasagawa, Yasuo [1 ]
Iizuka, Hideaki [1 ]
Yamashita, Masanobu [1 ]
Kawakami, Shigehiko [1 ]
机构
[1] Kanazawa Med Univ, Dept Neurosurg & Plast & Reconstruct Surg, Uchinada, Ishikawa 92002, Japan
关键词
Craniosynostosis; Distraction osteogenesis; Troubleshooting; EXTRADURAL DEAD SPACE; GRADUAL DISTRACTION; MONOBLOC ADVANCEMENT; MORBIDITY; CHILDREN;
D O I
10.1159/000369029
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose: We previously reported that distraction osteogenesis is less invasive and gives greater skull advancement compared to conventional cranioplasty [Akai et al: Pediatr Neurosurg 2006; 42: 288-292]. In this study, we analyzed the distraction osteogenesis process and tried to identify and solve various technical problems. Patients and Results: We operated on 22 patients, 5 syndromic and 17 nonsyndromic. During treatment, we encountered several problems: (i) dural laceration during craniotomy (2 cases), solution: repair by suturing with fascia; (ii) skull fracture at sphenofrontal or coronal sutures (2 cases), solution: completed distraction; (iii) device dislocation during distraction (1 case), solution: the device was secured to the skull with stainless wire; (iv) wound issues around shaft and device (3 cases), solution: treated with antibiotic ointment. Discussion: (1) Extra caution is needed to avoid dural damage at frontal bottom burr holes. (2) Completion of craniotomy should be confirmed by checking if the bone flap moves in sync with brain pulsation. The craniotomy line should be placed forward of coronal sutures. (3) For patients younger than 2 years, employ clamp-type devices. (4) Shafts should be cut short enough to prevent their tips from exerting pressure or puncturing the scalp from beneath. Conclusions: The distraction osteogenesis technique has complications that may not occur in conventional one-stage cranioplasty. In this study, neither age at operation nor distraction distance were significant causes of complications during distraction osteogenesis. (C) 2014 S. Karger AG, Basel
引用
收藏
页码:380 / 383
页数:4
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