An Algorithm for Managing Syndromic Craniosynostosis Using Posterior Vault Distraction Osteogenesis.
The authors hypothesize that early posterior vault distraction osteogenesis safely confers considerable cranial vault remodeling, sufficient to enable fronto-orbital advancement to be delayed to a later age, with improved outcomes.



The authors conducted a retrospective cohort study of children with syndromic craniosynostosis treated before (2003 to 2008) or after (2009 to 2014) implementation of posterior vault distraction osteogenesis.



Sixty children with syndromic craniosynostosis presented during the study period. Forty met inclusion criteria with care continuity and complete records: 22 before and 18 after implementation of posterior vault distraction osteogenesis. Only 11 patients (61 percent) who underwent initial posterior vault distraction osteogenesis required frontal advancement, at a mean follow-up of 4.0 years of age, compared with 22 patients (100 percent) before implementation of posterior vault distraction osteogenesis. Kaplan-Meier survival analysis indicated significant delay of first fronto-orbital advancement in the posterior vault distraction osteogenesis cohort compared with the pre-posterior vault distraction osteogenesis cohort (p = 0.011). Comparing treatment in the first 5 years of life among posterior vault distraction osteogenesis versus non-posterior vault distraction osteogenesis subcohorts of patients older than 5 years, there were significantly fewer fronto-orbital advancements performed (0.6 versus 1.5 per patient; p = 0.023).



Using early posterior vault distraction osteogenesis for patients with syndromic craniosynostosis significantly reduces the average number of fronto-orbital advancement procedures in the first 5 years of life, delays initial fronto-orbital advancement, and is likely to reduce the total number of major craniofacial procedures.



Therapeutic, III.
Philadelphia, Pa.|From The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.
Jordan W
JW
Swanson
Philadelphia, Pa.|From The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.
Fares
F
Samra
Philadelphia, Pa.|From The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.
Andrew
A
Bauder
Philadelphia, Pa.|From The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.
Brianne T
BT
Mitchell
Philadelphia, Pa.|From The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.
Jesse A
JA
Taylor
Philadelphia, Pa.|From The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania.
Scott P
SP
Bartlett
D000367:Age Factors; D000465:Algorithms; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D061345:Early Medical Intervention; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D019857:Osteogenesis, Distraction / Q000379:methods*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome