Distraction Osteogenesis Technique for the Treatment of Nonsyndromic Sagittal Synostosis

BACKGROUND Historically, surgical treatment of children with a delayed presentation of cranial synostosis required complex cranial vault reconstruction. Recently, less invasive options for surgical correction, such as internal distraction osteogenesis, have been explored. In this study, we describe the successful management of delayed presentation of sagittal synostosis using distraction osteogenesis. METHODS A bicoronal incision was made and 2 large rectangular osteotomies were performed bilaterally, involving the frontal, parietal, temporal and occipital bones. A 2 cm strut of bone over the sagittal sinus was preserved, creating bilateral free-floating bone segments. Two pairs of distractors were placed transversely, along the midline strut of bone, providing lateral distraction of these segments. This placement allowed maximum displacement at the apex of the cranial vault. Distraction was performed differentially at 1 mm per day anteriorly and 2 mm per day posteriorly, for a total of 17 days, allowing for a greater degree of expansion of the posterior vault. The consolidation phase lasted for 10 weeks. The distractors were removed via the same bicoronal incision and cranioplasty was performed to smooth prominent ridging at the margins of the distracted segments. RESULTS The child's cranial index improved from 0.67 preoperatively to 0.76 postoperatively. The overall vault contour was smooth with no bony defects. There was a significant cosmetic improvement of the child's head shape. No major complications requiring reoperation or rehospitalization were encountered. CONCLUSION The use of distraction osteogenesis to laterally expand the cranial vault is a useful alternative in the treatment of delayed presentation, nonsyndromic, sagittal synostosis.