An Evolved Algorithm for Managing Syndromic Craniosynostosis in the Era of Posterior Vault Distraction Osteogenesis
Jordan Swanson, M.D., Fares Samra, M.D., Brianne Mitchell, M.D., Ari M. Wes, B.A., Scott P. Bartlett, M.D., Jesse A. Taylor, M.D..
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: We propose that early cranial expansion with posterior vault distraction osteogenesis (PVDO) has enabled fronto-orbital advancement (FOA) to be delayed to a later age, with improved outcomes.
METHODS: We compared demographics, treatment, and early outcomes of children presenting with syndromic craniosynostosis before (2003-2008) and after (2009-2014) adoption of PVDO.
RESULTS: Sixty-two children with syndromic craniosynostosis presented during the study period: 30 prior to and 32 after implementation of PVDO. Twenty-nine patients (91%) in the second cohort underwent PVDO at a mean age of 0.775 years. For cohort comparisons, patients who presented after infancy or with incomplete charts were excluded. Demographic characteristics were similar between groups (Table 1). First FOA was performed at a mean age of 1.25 years in the pre-distraction cohort versus 2.02 years in the PVDO cohort (p=0.018, Table 2). A greater proportion of patients in the PVDO cohort required no FOA in the first four years of life (44% versus 14% p = 0.04).
CONCLUSION: Since incorporation of PVDO into the treatment of syndromic craniosynostosis, children undergo their first FOA at a later age with fewer early major revisions. This may have major implications on the quantity of cranial surgery these children receive throughout their lives.
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