Contralateral Coronal-Lambdoid Craniosynostosis Treated with Distraction Osteogenesis and Spring-Mediated Cranioplasty

Abstract

Introduction: Treatment of multi-sutural craniosynostosis presents unique challenges and requires a patient specific approach. Patients with contralateral multi-suture craniosynostosis are particularly challenging as the surgical technique utilized must induce opposing forces of expansion. When patients present early in life, early dynamic expansion may be preferable to open approaches. Herein we report a 2-stage technique to treat contralateral right unicoronal and left lambdoid synostosis with simultaneous distraction osteogenesis and spring-mediated cranioplasty. Methods: A 3-month-old male presented to our clinic for concern for head asymmetry. A CT scan confirmed right coronal and left lambdoid craniosynostosis. Preoperative and postoperative head CT and 3D photogrammetry were used to compute the Head Shape Anomaly index (HSA) and difference in head volume from a personalized normative reference for shape and volume. Results: The surgery lasted 163 minutes, and the patient received a 168 mL blood transfusion. The patient was discharged after 3 days. Two springs were placed following a 1 cm strip craniectomy of the lambdoid suture, and a 40 mm uniplane cranial distractor was placed after a right fronto-orbital osteotomy. Devices were removed following activation and consolidation phases. There were no major complications. Postoperative 3D head CT showed correction of left lambdoid and right coronal craniosynostosis with improved plagiocephaly. The patient’s postoperative HSA Index improved from 4.39 pre-operatively to 2.85 at 145 days post-operatively. In addition, the difference in intracranial volume from the personalized normative reference improved from -87.35 mL pre-operatively to 1.65 mL post-operatively. Conclusion: This early dynamic expansion technique provided improved safety outcomes including decreased operative time, transfusion requirement, and hospital stay when compared to other techniques for multi-suture correction such as cranial vault reconstruction. This technique also produced desired results in shape correction and correction of volumetric anomalies. This illustrates the importance of innovation to develop patient specific surgical designs that maximize safety and morphologic outcomes.