title: Results of posterior cranial vault remodeling for plagiocephaly and brachycephaly by the meander technique.
abstract: OBJECTIVE
  Several techniques to remodel the posterior calvarium in order to increase intracranial volume (ICV) and to improve cosmetic appearance are reported. This study presents the results of meander technique in patients with brachycephaly and posterior plagiocephaly.
  
  
  METHODS
  During December 2011 and July 2013, a total of 12 children (median age: 15 months) underwent posterior cranial vault remodeling by the meander technique (brachycephaly, n = 6; posterior plagiocephaly, n = 6). The available pre- and postoperative MRIs were assessed with regard to ICV, cranial index (CI) and asymmetry index (AI) as well as the position of the cerebellar tonsils.
  
  
  RESULTS
  No intra- or postoperative complications were observed. Blood transfusions were necessary in nine of 12 patients. A significant increase of the ICV from 1,178.4 ± 134.5 to 1,293.0 ± 137.5 cm(3) (p < 0.05) is demonstrated. In the patients with brachycephaly the CI was significantly improved from 0.97 ± 0.12 to 0.89 ± 0.12 postoperatively (p < 0.05). The AI in patients with posterior plagiocephaly was significantly ameliorated from 0.83 ± 0.04 to 0.92 ± 0.02 postoperatively (p < 0.05). There was a significant effect on cerebellar tonsil position in relation to foramen magnum level for patients with brachycephaly (right tonsil: 11.9 ± 9.2 to 7.0 ± 9.1 mm, p < 0.05; left: 10.8 ± 9.5 to 9.7 ± 10.6 mm; p < 0.05) as well as in posterior plagiocephaly for the ipsilateral tonsil (3.2 ± 3.5 to 1.6 ± 3.5 mm; p < 0.01).
  
  
  CONCLUSIONS
  The presented surgical technique is considered to be safe. The technique is capable to significantly increase ICV and improve cosmetic appearance of the remodeled calvarium. Further evidence that posterior cranial vault remodeling influences the position of the cerebellar tonsils is added by the results of the study.
authors.affiliation: Arbeitsbereich Pädiatrische Neurochirurgie, Charité Universitätsmedizin, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schulz
authors.forename: Birgit
authors.initials: B
authors.lastname: Spors
authors.forename: Hannes
authors.initials: H
authors.lastname: Haberl
authors.forename: Ulrich-Wilhelm
authors.initials: UW
authors.lastname: Thomale
mesh_terms: D016723:Bone Remodeling; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009989:Orthotic Devices; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D059041:Plagiocephaly / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012886:Skull / Q000502:physiology / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome