title: Troubleshooting distraction osteogenesis for craniosynostosis.
abstract: OBJECTIVE
  We previously reported that distraction osteogenesis is less invasive and gives greater skull advancement compared to conventional cranioplasty [Akai et al: Pediatr Neurosurg 2006;42:288-292]. In this study, we analyzed the distraction osteogenesis process and tried to identify and solve various technical problems.
  
  
  RESULTS
  We operated on 22 patients, 5 syndromic and 17 nonsyndromic. During treatment, we encountered several problems: (i) dural laceration during craniotomy (2 cases), solution: repair by suturing with fascia; (ii) skull fracture at sphenofrontal or coronal sutures (2 cases), solution: completed distraction; (iii) device dislocation during distraction (1 case), solution: the device was secured to the skull with stainless wire; (iv) wound issues around shaft and device (3 cases), solution: treated with antibiotic ointment.
  
  
  CONCLUSIONS
  (1) Extra caution is needed to avoid dural damage at frontal bottom burr holes. (2) Completion of craniotomy should be confirmed by checking if the bone flap moves in sync with brain pulsation. The craniotomy line should be placed forward of coronal sutures. (3) For patients younger than 2 years, employ clamp-type devices. (4) Shafts should be cut short enough to prevent their tips from exerting pressure or puncturing the scalp from beneath.
  
  
  CONCLUSIONS
  The distraction osteogenesis technique has complications that may not occur in conventional one-stage cranioplasty. In this study, neither age at operation nor distraction distance were significant causes of complications during distraction osteogenesis.
authors.forename: Takuya
authors.initials: T
authors.lastname: Akai
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Shiraga
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sasagawa
authors.forename: Hideaki
authors.initials: H
authors.lastname: Iizuka
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamashita
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Kawakami
mesh_terms: D016025:Bone Transplantation / Q000379:methods / Q000592:standards; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000379:methods* / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care