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This procedure uses the power of distraction osteogenesis to slowly expand an infant’s skull using special devices placed under the skin at the time of surgery. We use this technique to treat different types of craniosynostosis. Although can perform cranial distraction at any age, it is usually done when the infant is between 4 to 8 months old.
At Texas Children’s North Austin Campus we perform three types of cranial expansion using distraction osteogenesis:
In North Austin, we use posterior cranial vault distraction (PVDO) to expand the back of an infant’s skull affected by syndromic or multiple suture craniosynostosis. Our team uses this distraction osteogenesis technique in situations where the growing brain requires more space, but the child is too young for surgery on the front of the skull.
- PVDO is performed by a pediatric neurosurgeon and craniofacial surgeon at 4-9 months of age
- Only the most severe cases of craniosynostosis need PVDO
- Through a zig-zag coronal incision, the back of the skull is separated from the front with a thin cut in the bone
- Small distraction devices are placed across the bone separation line with activation posts that exit through the skin
Thin flexible activation posts slowly turn the distraction device that is buried under the skin. The posts are removed in clinic once turning has finished to allow the expanded skull to heal.
- The scalp is then closed and the surgery is over
- The day after surgery, the devices are turned at 1-2 mm/day for 2-3 weeks
- The devices open the separation in the bone so that the back of the skull slowly moves backwards and expands the volume of the skull.
- When the bone is in the correct position, we remove the outside device arms in clinic and the bone heals in the separation gap for 4-6 weeks.
- The devices under the skin are then removed during a day surgery procedure after bone healing
- In North Austin we offer anterior cranial vault distraction to infants born with unilateral coronal synostosis, which is a type of single suture craniosynostosis.
- This treatment can be used if an infant is less than 6 months old at the time of surgery
- It uses the same buried distraction devices used in posterior cranial vault distraction (PVDO), but only one device is used on the side of the fused suture
- Instead of the coronal incision used with open cranial vault remodeling, a small incision measuring just over two inches is made in the temple region as well as a small incision hidden in the fold of the upper eyelid.
- The surgery takes less than 2 hours and the time in hospital is usually 2-3 days
- We teach you how to turn the devices to bring your baby’s flatter forehead side forward. This usually takes two weeks.
- Once your baby’s forehead is in the correct position, the device stays in place to allow the bone to heal.
- We remove the device through the same scars two months after the first surgery.
- “Monobloc” means that the forehead, eye sockets and upper jaw all move forward as one piece or block
- Used for severe syndromic craniosynostosis to improve airway, expand skull and protect eyes at the same time
- Performed through the same coronal incision as other open cranial surgeries
- Performed at 1 to 4 years of age
- Can be needed by older patients if face and forehead are equally affected
- Involves a pediatric neurosurgeon and craniofacial surgeon working together
- The bones of the forehead and the upper face are separated so they move together
- An external skull mounted halo distraction device is placed at the time of surgery
- The halo is attached to the bones of the face and forehead by wires that pass through the skin
- Patients spend 2 nights in the ICU and 5-7 days in the hospital
- The distraction device attached to the halo is turned after surgery for two weeks to bring the forehead and face forward
- The device is left in place for two months then removed as a day surgery
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