title: Posterior cranial vault expansion in the treatment of craniosynostosis. Comparison of current techniques.
abstract: BACKGROUND
  Surgical procedures which aim at expanding the posterior cranial vault have come to play an increasingly important role in the treatment of syndromic craniosynostosis. The posterior cranial vault may be expanded by formal cranioplasty or by less invasive methods based on gradual posterior cranial vault expansion or distraction. These procedures share the common goals to prevent intracranial hypertension and progression toward turricephaly by effectively increasing the intracranial volume. They also reduce any local brain compression within the posterior cranial fossa.
  
  
  METHODS
  This review describes the various techniques available for less invasive and gradual posterior cranial vault expansion and their rationale based on our experience on the last 40 cases. Volumetric data for three different surgical techniques have been compared (two cases of posterior cranial vault expansion by free-floating parieto-occipital bone flap, two with springs, and two with internal distractors). The volumetric analysis showed an expansion of 13 and 24 % for the free posterior flap, 18 and 25 % for the translambdoid springs, and 22 and 29 % for the distractors.
  
  
  CONCLUSIONS
  Although these figures are not strictly comparable, our data suggest that these three techniques offer a potential for a significant increase in skull volume. The indications for such procedures must, however, be tailored according to the age and condition of the single patient.
authors.affiliation: Craniofacial Center, Department of Plastic and Maxillofacial Surgery and Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nowinski
authors.forename: Federico
authors.initials: F
authors.lastname: Di Rocco
authors.forename: Dominique
authors.initials: D
authors.lastname: Renier
authors.forename: Christian
authors.initials: C
authors.lastname: SainteRose
authors.forename: Junnu
authors.initials: J
authors.lastname: Leikola
authors.forename: Eric
authors.initials: E
authors.lastname: Arnaud
mesh_terms: D003398:Craniosynostoses / Q000601:surgery*; D006801:Humans; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods*; D009777:Occipital Bone / Q000601:surgery*; D013524:Surgical Flaps