title: Expansion and compression distraction osteogenesis based on volumetric and neurodevelopmental analysis in sagittal craniosynostosis.
abstract: OBJECTIVE
  Distraction osteogenesis (DO) is a less daunting procedure than extensive cranial vault remodeling and has been used to correct sagittal craniosynostosis. The purposes of this study are to describe DO in combination with expansion and compression procedures and to report analytic results based on the cranial index (CI), volumetric measurement, and neurodevelopmental tests.
  
  
  METHODS
  Between June 2002 and May 2013, 32 patients with non-syndromic sagittal synostosis who had undergone antero-posterior compression with bitemporal expansion were recruited. Circumferential baseline, mid-sagittal, and bicoronal craniotomies were performed in addition to four-quadrant bone flap procedures via distraction with dural attachment. CI, intracranial volume (ICV), head circumference (HC), and neurodevelopmental outcomes using the Bayley Scales of Infant Development-II (BSID-II) scoring system were analyzed.
  
  
  RESULTS
  Dolichocephalic CI (68.85 ± 3.61) was altered to mesocephalic CI (78.28 ± 3.74) postoperatively. Preoperative ICV and HC determinations were within the normal range for the majority of participants (normal ICV 87.5%, n = 28; normal HC 75%, n = 24). ICV and HC did not show significant changes with postoperative measurements and were maintained within normal ranges. Regarding neurodevelopment, both the mental and psychomotor developmental indices (MDI, PDI) demonstrated significant improvement (MDI, 88.69 ± 17.38 to 96.23 ± 21.05; PDI, 91.38 ± 16.31 to 100 ± 11.51; p < 0.05).
  
  
  CONCLUSIONS
  Symmetric sagittal synostosis can be treated comprehensively through DO in combination with expansion and compression procedures. ICV and HC measurements were useful for designing surgical and postoperative distraction strategies. Achievement of mesocephalic CI and neurodevelopmental improvement validated morphological and functional effectiveness.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine, Seoul, South Korea.
authors.forename: Myung Chul
authors.initials: MC
authors.lastname: Lee
authors.affiliation: Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyu Won
authors.initials: KW
authors.lastname: Shim
authors.affiliation: Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Park
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: In Sik
authors.initials: IS
authors.lastname: Yun
authors.affiliation: Department of Pediatric Neurosurgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Dong Seok
authors.initials: DS
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Republic of Korea. sgm625@yuhs.ac.|Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University Health System, 250 Seongsan-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. sgm625@yuhs.ac.
authors.forename: Yong Oock
authors.initials: YO
authors.lastname: Kim
mesh_terms: D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D002658:Developmental Disabilities / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D019857:Osteogenesis, Distraction / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Cranial index; Distraction osteogenesis; Head circumference; Intracranial volume; Neurodevelopment; Sagittal craniosynostosis