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Posterior Vault Distraction and Osteogenesis: a single institution’s experience
Jing Li, M.D., Wen Xu, B.S., Patrick Gerety, M.D., Scott Bartlett, M.D., Jesse Taylor, M.D..
Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Purpose: There is growing literature on the advantages of posterior cranial vault distraction (PVDO) in treating syndromic craniosynostosis. This study aims to describe our institution’s evolving use of PVDO.
Methods: A prospective craniofacial database of patients was queried for cases involving PVDO from 2009 to 2015. An age of 5 years or older was used to distinguish older from younger subjects. Demographic, perioperative, and distraction data was collected. Older and younger groups were compared using a Wilcoxon rank-sum and Fisher’s exact test.
Results: Forty-two cases met inclusion criteria with 93.8% involving syndromics and 31% with prior craniofacial surgery. Average age was 3.1 years with a range of 0.3 to 14.1 years. Demographic and perioperative data is shown in Table 1. Average duration of distraction was 25.5 days with 26.4 mm distracted. Complications occurred in 21.4% while 19% required immediate postoperative blood transfusion. Resolution of symptoms was found in 95.2% in short-term follow-up. Reported cases were followed by further craniofacial reconstruction 52.3%. Statistically, the older group had less weight-based blood loss (p=0.0007) and transfusion volumes (p=0.0001), as well as shorter follow-up (p=0.0288).
Conclusions: PVDO is a safe and efficacious method of cranial vault expansion in children with craniosynostosis, with similar perioperative outcomes in older and younger patients. Future work will focus on optimization of timing of surgery, as well as ways to decrease perioperative morbidity.
Table 1: Demographic and Perioperative Data
Older SubjectsYounger Subjectsp valueTotal
n103242
Male5 (50%)10 (31.2%)0.45115 (35.7%)
Age (years)9.2 ± 3.31.5 ± 13<0.000053.3 ± 3.8
Weight (kg)33.4 ± 19.110.1 ± 3.8<0.0000515.6 ± 13.9
Inpatient status0 (0%)3 (9.4%)0.9993 (7.1%)
Syndromic10 (100%)26 (81.3%)0.30836 (85.7%)
Prior craniofacial surgery5 (50%)8 (25%)0.23813 (31%)
Prior PVDO1 (10%)2 (6.3%)0.9993 (7.1%)
Barrel stave osteotomy8 (80%)30 (93.8%)0.23638 (90.5%)
Procedure duration (min)163.8 ± 31.2168.5 ± 57.60.7465167.3 ± 52.2
Anesthesia duration (min)278.5 ± 50.6299.1 ± 53.20.309294.0 ± 52.7
Blood loss (cc)420.0 ± 161.9480.7 ± 395.4†0.8138465.5 ± 350.7**
Weight-based blood loss (cc/kg)14.6 ± 7.051.9 ± 46.0†0.000742.6 ± 43.0**
Intraoperative transfusion (cc)590.6 ± 183.2601.7 ± 355.80.6259599.0 ± 321.1
Weight-based transfusion (cc/kg)21.2 ± 9.963.4 ± 38.20.000153.4 ± 38.2
Decrease in Hg POD#0 (g/dL)1.2 ± 1.30.2 ± 2.10.17870.4 ± 1.9
Decrease in Hg POD#1 (g/dL)3.3 ± 3.7‡1.4 ± 2.10.18061.8 ± 2.6*
Postoperative transfusion0 (0%)7 (21.9%)0.1687 (19%)
ICU length of stay (days)
Outpatient2.1 ± 0.72.6 ± 1.10.15362.5 ± 1.0
Inpatient.119.3 ± 198.9.119.3 ± 198.9
Hospital length of stay (days)
Outpatient3.9 ± 1.13.8 ± 1.00.773.8 ± 1.0
Inpatient.173.7 ± 168.0.173.7 ± 168.0
Duration of distraction (days)22.2 ± 6.226.3 ± 10.70.267125.3 ± 9.9
Distraction length (mm)25.4 ± 4.826.7 ± 7.10.563626.4 ± 6.6
Duration of consolidation (days)69.0 ± 14.260.6 ± 20.30.164462.6 ± 19.2
Time to follow up (months)16.0 ± 14.831.3 ± 20.80.028827.5 ± 20.4
Complications1 (10%)8 (25%)0.4169 (21.4%)
Epidural hematoma0 (0%)1 (3.1%)0.9991 (2.3%)
Wound Infection1 (10%)6 (18.8%)0.9997 (16.7%)
CSF leak0 (0%)2 (6.3%)0.9992 (4.8%)
Symptom resolution10 (100%)30 (93.8%)0.99940 (95.2%)
Further craniofacial surgery3 (30%)19 (59.4%)0.15222 (52.3%)
*n=41, **n=40, †n=30, ‡n=9


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