Posterior calvarial distraction in craniosynostosis - an evolving technique.

BACKGROUND: Posterior advancement of the occiput is an established surgical option for the treatment of raised intracranial pressure (ICP) secondary to craniocerebral disproportion in syndromic craniosynostoses. Distraction osteogenesis has gained popularity in a variety of craniofacial procedures to achieve greater advancement in the anterior craniofacial skeleton, but has only relatively recently been used in the posterior calvarium. We report the Oxford Craniofacial Unit's experience of using distraction techniques to expand the occiput. METHODS: We preformed a retrospective casenote review of all patients with syndromic craniosynostoses who underwent posterior distraction at our centre from 2007 to 2010, as identified by the Oxford Craniofacial Database. RESULTS: Ten syndromic patients underwent posterior distraction (mean age of 18.1 months). Successful calvarial expansion (mean advancement of 19.7 mm) was achieved in all patients clinically and radiologically. There were 6 minor and 1 major complications. CONCLUSIONS: Posterior distraction was successfully performed in 10 patients including babies as young as 3 months of age. It achieved a reduction in turricephaly, an improvement in the cephalic index, and a resolution of raised ICP. We have customised our surgical technique to address individual patient needs. The use of distraction techniques in the occiput appears to increase the reliability of expansion in this region.