Background: Techniques for sagittal synostosis correction continue to evolve, thus resulting in improved outcomes and minimized morbidity. Spring-assisted cranioplasty and strip craniotomy with postoperative helmet usage are simple minimally invasive surgeries. However, these procedures are only useful in younger patients (generally up to 9 months of age); older children usually undergo total cranial remodeling, which is more stressful. We have developed a procedure combining morcellation craniotomy with distraction osteogenesis (MoD), which we have been performing since 2000. Here, we describe and evaluate this method of treatment. Methods: Seven patients who underwent MoD for isolated sagittal synostosis were followed for 10 years postoperatively. The control group consisted of 7 patients who had undergone total cranial remodeling in the period immediately preceding the MoD operations. Cephalography, clinical examinations, medical record data and medical photographs were used to evaluate and compare the 2 groups. Results: In comparison with total cranial remodeling, the MoD procedure resulted in a significantly shorter mean operation time and a significantly lower mean blood transfusion volume. The postoperative cephalic index was not significantly different between the MoD (75.8 ± 0.9) and the control groups (75.6 ± 1.4), and satisfactory cranial shape volumes were achieved without serious complications. Conclusion: The MoD procedure is a safe, effective and reliable technique for dynamic total skull remodeling with minimal morbidity. It can be used to improve upon previous surgical concepts for treating scaphocephaly, particularly in older patients.

1.
Persing JA: MOC-PS(SM) CME article: management considerations in the treatment of craniosynostosis. Plast Reconstr Surg 2008;121:1-11.
2.
Marucci DD, Johnston CP, Anslow P, Jayamohan J, Richards PG, Wilkie AO, Wall SA: Implications of a vertex bulge following modified strip craniectomy for sagittal synostosis. Plast Reconstr Surg 2008;122:217-224.
3.
Barone CM, Jimenez DF: Endoscopic craniectomy for early correction of craniosynostosis. Plast Reconstr Surg 1999;104:1965-1973.
4.
Jimenez DF, Barone CM: Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg 1998;88:77-81.
5.
Windh P, Davis C, Sanger C, Sahlin P, Lauritzen C: Spring-assisted cranioplasty vs pi-plasty for sagittal synostosis - a long term follow-up study. J Craniofac Surg 2008;19:59-64.
6.
Mackenzie KA, Davis C, Yang A, MacFarlane MR: Evolution of surgery for sagittal synostosis: the role of new technologies. J Craniofac Surg 2009;20:129-133.
7.
Marchac D, Renier D: Le front flottant, traitement précoce des faciocraniosténoses. Ann Chir Plast 1979;24:121-126.
8.
Roddi R, Vaandrager JM, Gilbert PM, van der Meulen JC: Reshaping of the skull in the early surgical correction of scaphocephaly. J Craniomaxillofac Surg 1993;21:226-233.
9.
Persing JA, Luce C: Remodeling techniques for immature and mature cranial vault bone: technical note. J Craniofac Surg 1990;1:147-149.
10.
Jane JA Sr, Jane JA Jr: Treatment of craniosynostosis. Clin Neurosurg 1996;43:139-162.
11.
Lauritzen C, Friede H, Elander A, et al: Dynamic cranioplasty for brachycephaly. Plast Reconstr Surg 1996;98:7-14.
12.
Salyer KE: Salyer and Bardach's Atlas of Craniofacial and Cleft Surgery. Philadelphia, Lippincott-Raven, 1999, vol I: Craniofacial surgery.
13.
Amaral CMR, Domizio GD, Tiziani V, et al: Gradual bone distraction in craniosynostosis. Scand J Plast Reconstr Hand Surg 1997;31:25-37.
14.
Talisman R, Hemmy DC, Denny AD: Frontofacial osteotomies, advancement and remodeling by distraction: an extended application of technique. J Craniofac Surg 1997;8:308-317.
15.
Hirabayashi S, Sugawara Y, Sakuraia A, et al: Frontoorbital advancement by gradual distraction: technical note. J Neurosurg 1996;89:1058-1061.
16.
Cho BC, Hwang SK, Uhm KI: Distraction osteogenesis of the cranial vault for the treatment of craniofacial synostosis. J Craniofac Surg 2004;15:135-144.
17.
Choi JW, Koh KS, Hong JP, Hong SH, Ra Y: One-piece frontoorbital advancement with distraction but without a supraorbital bar for coronal craniosynostosis. J Plast Reconstr Aesthet Surg 2009;62:1166-1173.
18.
Komuro Y, Hashizume K, Koizumi T, Miyajima M, Nakanishi H, Arai H: Cranial expansion with distraction osteogenesis for multiple-suture synostosis in school-aged children. J Craniofac Surg 2009;20:457-460.
19.
Kim YO, Choi JW, Kim DS, Lee WJ, Yoo SK, Kim HJ, Choi JE, Park B: Cranial growth after distraction osteogenesis of the craniosynostosis. J Craniofac Surg 2008;19:45-55.
20.
Lao WW, Denny AD: Internal distraction osteogenesis to correct symptomatic cephalocranial disproportion. Plast Reconstr Surg 2010;126:1677-1688.
21.
Nakajima H, Sakamoto Y, Tamada I, Ohara H, Kishi K: Dynamic total skull remodeling by a combination of morcellation craniotomy with distraction osteogenesis: the MoD procedure. J Craniofac Surg 2011;22:1240-1246.
22.
Arnaud E, Renier D, Marchac D: Prognosis for mental function in scaphocephaly. J Neurosurg 1995;83;476-479.
23.
Marchac D, Arnaud E, Renier D: Frontocranial remodeling without opening of frontal sinuses in a scaphocephalic adolescent: a case report. J Craniofac Surg 2002;13:698-705.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.