Multidirectional Cranial Distraction Osteogenesis with Simplified Modifications for Treating Sagittal Synostosis

Ataru Sunaga, MD; Yasushi Sugawara, MD; Hideaki Kamochi, MD, DDS; Akira Gomi, MD; Daekwan Chi, MD; Rintaro Asahi, MD; Masanori Mori, MD; Shunji Sarukawa, MD; Hirokazu Uda, MD; Kotaro Yoshimura, MD

doi:10.1097/GOX.0000000000001536

Plastic and Reconstructive Surgery, Global Open (Oct 2017)

Multidirectional Cranial Distraction Osteogenesis with Simplified Modifications for Treating Sagittal Synostosis

Ataru Sunaga, MD,
Yasushi Sugawara, MD,
Hideaki Kamochi, MD, DDS,
Akira Gomi, MD,
Daekwan Chi, MD,
Rintaro Asahi, MD,
Masanori Mori, MD,
Shunji Sarukawa, MD,
Hirokazu Uda, MD,
Kotaro Yoshimura, MD

Affiliations

Ataru Sunaga, MD: From the *Department of Pediatric Plastic Surgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan; †Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan; and ‡Department of Pediatric Neurosurgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan.
Yasushi Sugawara, MD: From the *Department of Pediatric Plastic Surgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan; †Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan; and ‡Department of Pediatric Neurosurgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan.
Hideaki Kamochi, MD, DDS: From the *Department of Pediatric Plastic Surgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan; †Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan; and ‡Department of Pediatric Neurosurgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan.
Akira Gomi, MD: From the *Department of Pediatric Plastic Surgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan; †Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan; and ‡Department of Pediatric Neurosurgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan.
Daekwan Chi, MD: From the *Department of Pediatric Plastic Surgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan; †Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan; and ‡Department of Pediatric Neurosurgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan.
Rintaro Asahi, MD: From the *Department of Pediatric Plastic Surgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan; †Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan; and ‡Department of Pediatric Neurosurgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan.
Masanori Mori, MD: From the *Department of Pediatric Plastic Surgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan; †Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan; and ‡Department of Pediatric Neurosurgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan.
Shunji Sarukawa, MD: From the *Department of Pediatric Plastic Surgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan; †Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan; and ‡Department of Pediatric Neurosurgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan.
Hirokazu Uda, MD: From the *Department of Pediatric Plastic Surgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan; †Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan; and ‡Department of Pediatric Neurosurgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan.
Kotaro Yoshimura, MD: From the *Department of Pediatric Plastic Surgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan; †Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan; and ‡Department of Pediatric Neurosurgery, Jichi Children’s Medical Center Tochigi, Tochigi, Japan.

DOI: https://doi.org/10.1097/GOX.0000000000001536
Journal volume & issue: Vol. 5, no. 10
p. e1536

Abstract

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Background:. Multidirectional cranial distraction osteogenesis (MCDO) is a procedure of ours developed earlier for treating craniosynostosis. However, the numerous bone flaps led to prolonged operative time and occasional bone detachment from dura. We have since simplified the osteotomy design. In treating sagittal synostosis, required bone flaps have been reduced to 11 (from ~20). Methods:. In a 2-year period (2014–2015), 5 boys with sagittal synostosis underwent MCDO using our simplified and fixed-form osteotomy. Mean age at surgery was 9.4 months (range, 8–11 months). Pre- and postoperative cranial morphology was assessed by cephalic index and by mid-sagittal vector analysis. Results:. Improved cranial shape was confirmed by 3-dimensional CT scans and by mid-sagittal vector index. Mean preoperative cephalic index (68.7) progressively increased to means of 78.5 immediately after distraction device removal, 75.2 at postoperative month 6, and 75.1 at 1 year postoperatively. There were no major complications, although transient cerebrospinal fluid leakage and loosening of anchor pins occurred in 1 patient. Conclusions:. Simplified MCDO has a number of advantages over conventional distraction procedures such as discretionary reshaping/expansion of cranium and predictable osteogenesis and is a valid treatment option for patients with sagittal synostosis.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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