UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Two-Center Review of Posterior Vault Expansion following a Staged or Expectant Treatment of Crouzon and Apert Craniosynostosis

Breakey, Richard WF; Mercan, Ezgi; van de Lande, Lara S; Sidpra, Jai; Birgfeld, Craig; Lee, Amy; Schievano, Silvia; ... Hopper, Richard A; + view all (2023) Two-Center Review of Posterior Vault Expansion following a Staged or Expectant Treatment of Crouzon and Apert Craniosynostosis. Plastic and Reconstructive Surgery , 151 (3) pp. 615-626. 10.1097/PRS.0000000000009925. Green open access

[thumbnail of A_Two_Center_Review_of_Three_Techniques_for.1315.pdf]
Preview
Text
A_Two_Center_Review_of_Three_Techniques_for.1315.pdf - Accepted Version

Download (1MB) | Preview

Abstract

INTRODUCTION: Timing of posterior cranial expansion for the management of intracranial pressure can be 'staged' by age and dysmorphology or 'expectant' by pressure monitoring. We report shared outcome measures from one center performing posterior vault remodeling (PCVR) or distraction (PVDO) following a 'staged' approach and another performing spring assisted expansion (SAPVE) following an 'expectant' protocol. METHODS: Apert or Crouzon syndrome cases who underwent posterior expansion less than two years old were included. Perioperative outcomes and subsequent cranial surgeries were recorded up to last follow-up and intracranial volume changes measured and adjusted using growth curves. RESULTS: 38 patients were included. Following the 'expectant' protocol, Apert cases underwent SAPVE at a younger age (8 months) than Crouzon cases (16 months). The initial surgery time was shorter but total operative time, including device removal, longer for PVDO (3:52) and SAPVE (4:34) than for PCVR (3:24). Growth-adjusted volume increase was significant and comparable. 14% PCVR, 33% PVDO, and 11% SAPVE cases had complications, but without long-term deficits. Following the staged approach, 5% only underwent PVDO, 85% had a staged posterior followed by anterior surgery, and 10% required a third expansion. Following the expectant approach, 42% patients had only posterior expansion at last follow-up, 32% had a secondary cranial surgery, and 26% had a third cranial expansion. CONCLUSIONS: Two approaches involving posterior vault expansion in young syndromic patients using three techniques resulted in comparable early volume expansion and complication profiles.

Type: Article
Title: Two-Center Review of Posterior Vault Expansion following a Staged or Expectant Treatment of Crouzon and Apert Craniosynostosis
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/PRS.0000000000009925
Publisher version: https://doi.org/10.1097/PRS.0000000000009925
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Childrens Cardiovascular Disease
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Biology and Cancer Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10165040
Downloads since deposit
37Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item