The Total Calvarial Transsutural Distraction Osteogenesis for 26 Children with Slit Ventricle, Craniosynostosis, or Microcephaly After Shunt Operation

Abstract

OBJECTIVE: Among shunt complications, the postshunt slit ventricle (PSSV) and the postshunt craniosynostosis (PSCS) may be managed by shunt valve upgrade and/or cranial expansion surgery. Here, we analyzed 26 children with PSSV, PSCS, or microcephaly who received simple generalized cranial expansion (ie, total calvarial transsutural distraction osteogenesis [TC-TSuDO]). METHODS: Among 254 children with shunt surgery, 26 children received TC-TSuDO. These 26 children included 14 with PSSV, 4 with PSCS, and 8 with both PSSV and PSCS. The mean age of patients who underwent shunt procedures was 8.2 +/- 10.6 months, and the mean time interval from shunt surgery to TC-TSuDO was 26.8 +/- 29.5 months. The mean age of children at the time of TC-TSuDO was 33.3 +/- 30.2 months. We analyzed head circumferences, lumbar puncture pressures, development status, operative factors, and postoperative complications. RESULTS: The mean preoperative head circumference was -2.1 +/- 1.9, which increased to -1.4 +/- 2.1 (P < 0.001) postsurgically. The mean preoperative lumbar puncture pressure was 26.2 +/- 10.7 cm H2O which decreased to 11.9 +/- 3.5 cm H2O (P < 0.001) after surgery. The mean operation time was 138 +/- 66 minutes. The mean intensive care unit stay was 0.27 +/- 0.53 days. There were no mortalities but 2 patients suffered from distractor malfunction and 1 patient showed wound discharge. CONCLUSIONS: We suggest that postshunt complications such as PSSV or PSCS, especially those that are accompanied by increased intracranial pressure or postshunt microcephaly, may be managed for patients with TC-TSuDO, which has been shown to be safe, simple, and effective.