title: Cranial vault expansion with the split bone flap technique in shunt-related craniosynostosis.
abstract: BACKGROUND
  Shunt-related craniosynostosis causing craniocerebral disproportion represents a particular complication of the treatment of hydrocephalus. When the modification of the shunt opening pressure does not improve the symptomatology, surgery for correction of craniocerebral disproportion is indicated. We present the results and advantages of the split bi-frontal bone technique that is a modification of the previous used frontal bone advancement technique.
  
  
  METHODS
  We retrospectively reviewed 5 patients with iatrogenic craniosynostosis treated in our institution from 1995 to 2012. A splitting bi-frontal bone flap that is left floating posteriorly was performed to increase the cranial volume.
  
  
  RESULTS
  All patients were cured. This technique increases the volume of the skull favoring the expansion of the brain and allows good cosmetical results. No perioperative complications were reported.
  
  
  CONCLUSIONS
  The fact that the brain has a more appropriate volume allows the disappearance of the clinical symptomatology related to the split ventricle syndrome. The advantage is the respect of the fronto-orbital shape in children and adults with the same results of the classic frontal advancement in terms of volume expansion. The study of cerebral blood flow confirms the increase of the cerebral blood perfusion and the improvement of the regional cerebral blood flow in borderline regions. We preconize, for the treatment of slit ventricle syndrome, the bi-frontal split technique in children and adults for its efficacy, the low rate of complications and the respect of aesthetical constraints.
authors.affiliation: Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France.
authors.forename: P-A
authors.initials: PA
authors.lastname: Beuriat
authors.affiliation: Department of Oral and Maxillofacial Surgery, Mother and Children Hospital, 59, boulevard Pinel, 69677 Lyon cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Paulus
authors.affiliation: Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France.
authors.forename: B
authors.initials: B
authors.lastname: Grassiot
authors.affiliation: Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France.
authors.forename: A
authors.initials: A
authors.lastname: Szathmari
authors.affiliation: Department of Pediatric Neurosurgery, Neurological and Neurosurgical Hospital Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron, France. Electronic address: carmine.mottolese@chu-lyon.fr.
authors.forename: C
authors.initials: C
authors.lastname: Mottolese
mesh_terms: D016025:Bone Transplantation / Q000379:methods; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000209:etiology* / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019857:Osteogenesis, Distraction / Q000379:methods*; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps
keywords: Craniosténose; Craniosynostosis; Hydrocephalus; Hydrocéphalie; Slit ventricle syndrome; Syndrome des ventricules fentes