The evolution of a new Craniofacial Procedure: From Concept to established Intervention. The 8 year history of Posterior Calvarial Osseodistraction and its use in Craniofacial Surgery

Introduction: Posterior Calvarial Osseodistraction was first presented at the annual scientific meeting BAOMS, Aviemore, 2007 by the lead author. Its indication was to alleviate raised intracranial pressure in syndromic craniosynostotic patients. Since then the procedure has been accepted and used in many craniofacial surgery units worldwide. In addition in some patients with Chiari malformation at the craniocervical junction, there is regression of the Chiari and improvement in symptoms when this technique is used. Method: We prospectively collected data for the 38 cases who have undergone this intervention in our unit in the 8 years since the inception of the technique. Parameters measured included age, diagnosis, indication, distraction distance achieved and complications. Results: There have been modifications in the technique and distractors used in the study period.. 22 patients had a confirmed craniofacial syndrome. The majority of patients required the procedure for raised intracranial pressure (n=24); other indications were Chiari malformation (n= 2) and Chiari malformation with syrinx (n=2). This will be discussed further. Complications of the procedure are discussed and include cerebro spinal fluid leaks (n= 5) and distractor loosening (n=5). Conclusion: Posterior Calvarial Osseodistraction is an accepted intervention for increasing intracranial volume in patients who have premature sutural fusion. It is used in our unit as an adjunct in the management of complex craniofacial patients.