Introduction: Distraction osteogenesis (DO) is an evolving methodology in the treatment of craniosynostosis. The addition of in situ techniques may be theoretically advantageous. We review our initial single center experience in the treatment of single and multisutural craniosynostosis utilizing standard and in situ distraction osteogenesis.
Methods: A retrospective review was conducted of patients undergoing DO for repair of craniosynostosis at our institution from 2013-2017. All procedures were performed by the same neurosurgeon and craniofacial plastic surgeon (HSM, AAG). Comparisons between in situ and traditional DO were completed using the Mann-Whitney U Test.
Results: 31 patients underwent DO (19 in situ, 12 with removal and then replacement of cranial autografts). Of the in situ patients, there were 8 unicoronal, 1 lambdoid, and 10 multisutural patients. The median age was 8.61 months. 8 patients (all unicoronal) had anterior DO and 11 had posterior DO. Of the non in situ patients, there were 9 unicoronal and 3 multisutural. The median age was 10.10 months. 11 had anterior DO and 1 had posterior (p<0.05 as compared to in situ). 13 (42%) of patients received bilateral distractors. 18 (58%) had unilateral distractors (16 with unicoronal craniosynostosis). Estimated percent blood loss (18% vs. 18.9%), median operating time (166 vs. 179 minutes), median length of stay (3 vs. 4 days), and consolidation duration (136 vs. 151.5 days) did not differ statistically between in situ and non in situ DO, whereas in situ DO had greater median distraction length (30 vs. 19 mm, p<0.05), distraction duration (32 vs. 13 days, p<0.05), and volume change (312.4 vs. 156.5 cc, p<0.05). 97% of patients were transfused, with lower % volume for in situ than non in situ (27% vs. 34%, p<0.05).
Conclusions: In situ DO allows for greater distraction length, greater intracranial volume expansion, and lower % volume transfused than non in situ DO.
Patient Care: By identifying appropriate treatment paradigms for children with craniosynostosis.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of novel techniques in the treatment of craniosynostosis, 2) Discuss, in small groups, outcome measures for craniosynostosis, 3) Identify an effective treatment for single and multisutural craniosynostosis