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Expansion and compression distraction osteogenesis based on volumetric and neurodevelopmental analysis in sagittal craniosynostosis

 Myung Chul Lee  ;  Kyu Won Shim  ;  Eun Kyung Park  ;  In Sik Yun  ;  Dong Seok Kim  ;  Yong Oock Kim 
 Child's Nervous System, Vol.31(11) : 2081-2089, 2015 
Journal Title
 Child's Nervous System 
Issue Date
Cephalometry ; Child ; Child, Preschool ; Craniosynostoses/surgery* ; Developmental Disabilities/diagnosis* ; Female ; Follow-Up Studies ; Humans ; Imaging, Three-Dimensional ; Infant ; Male ; Neuropsychological Tests ; Osteogenesis, Distraction/methods* ; Postoperative Complications/diagnosis* ; Retrospective Studies ; Statistics, Nonparametric ; Tomography, X-Ray Computed ; Treatment Outcome
Cranial index ; Distraction osteogenesis ; Head circumference ; Intracranial volume ; Neurodevelopment ; Sagittal craniosynostosis
PURPOSE: 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.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
김동석(Kim, Dong Seok)
김용욱(Kim, Yong Oock) ORCID logo https://orcid.org/0000-0002-3756-4809
박은경(Park, Eun Kyung)
심규원(Shim, Kyu Won) ORCID logo https://orcid.org/0000-0002-9441-7354
윤인식(Yun, In Sik) ORCID logo https://orcid.org/0000-0003-1103-7047
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