Two-Center Review of Posterior Vault Expansion following a Staged or Expectant Treatment of Crouzon and Apert Craniosynostosis.

Autor:	Breakey RWF; From UCL Great Ormond Street Institute of Child Health, and Craniofacial Unit, Great Ormond Street Hospital for Children., Mercan E; The Craniofacial Center, Seattle Children's Hospital., van de Lande LS; From UCL Great Ormond Street Institute of Child Health, and Craniofacial Unit, Great Ormond Street Hospital for Children., Sidpra J; From UCL Great Ormond Street Institute of Child Health, and Craniofacial Unit, Great Ormond Street Hospital for Children., Birgfeld C; The Craniofacial Center, Seattle Children's Hospital.; the Division of Plastic Surgery, Department of Surgery., Lee A; The Craniofacial Center, Seattle Children's Hospital.; Department of Neurological Surgery, University of Washington., Schievano S; From UCL Great Ormond Street Institute of Child Health, and Craniofacial Unit, Great Ormond Street Hospital for Children., Dunaway DJ; From UCL Great Ormond Street Institute of Child Health, and Craniofacial Unit, Great Ormond Street Hospital for Children., Jeelani NO; From UCL Great Ormond Street Institute of Child Health, and Craniofacial Unit, Great Ormond Street Hospital for Children., Hopper RA; The Craniofacial Center, Seattle Children's Hospital.; the Division of Plastic Surgery, Department of Surgery.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2023 Mar 01; Vol. 151 (3), pp. 615-626. Date of Electronic Publication: 2022 Nov 22.
DOI:	10.1097/PRS.0000000000009925
Abstrakt:	Background: The timing of posterior cranial expansion for the management of intracranial pressure can be "staged" by age and dysmorphology or "expectant" by pressure monitoring. The authors report shared outcome measures from one center performing posterior vault remodeling (PCVR) or distraction (PVDO) following a staged approach and another performing spring-assisted expansion (SAPVE) following an expectant protocol. Methods: Apert or Crouzon syndrome patients who underwent posterior expansion younger than 2 years were included. Perioperative outcomes and subsequent cranial operations were recorded up to last follow-up and intracranial volume changes measured and adjusted using growth curves. Results: Thirty-eight patients were included. Following the expectant protocol, Apert patients underwent SAPVE at a younger age (8 months) than Crouzon patients (16 months). The initial surgery time was shorter but total operative time, including device removal, was longer for PVDO (3 hours 52 minutes) and SAPVE (4 hours 34 minutes) than for PCVR (3 hours 24 minutes). Growth-adjusted volume increase was significant and comparable. Fourteen percent of PCVR, 33% of PVDO, and 11% of SAPVE cases had complications, but without long-term deficits. Following the staged approach, 5% underwent only PVDO, 85% had a staged posterior followed by anterior surgery, and 10% required a third expansion. Following the expectant approach, 42% of patients had only posterior expansion at last follow-up, 32% had a secondary cranial surgery, and 26% had a third cranial expansion. Conclusion: Two approaches involving posterior vault expansion in young syndromic patients using three techniques resulted in comparable early volume expansion and complication profiles. Clinical Question/level of Evidence: Therapeutic, III. (Copyright © 2022 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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