Use of Multidirectional Cranial Distraction Osteogenesis for Cranial Expansion in Syndromic Craniosynostosis

1 Patients with syndromic craniosynostosis display considerable impairment of skull growth and often require cranial expansion to prevent the development of intracranial hypertension within the first year of life. However, the best approach for cranial expansion in this setting remains controversial. Although fronto-orbital advancement (FOA) was a typical option,1 this procedure is plagued by high rates of relapse.2 Distraction osteogenesis was introduced in 1998 as a means of expanding the cranium in patients with craniosynostosis,3 and this method has continued to gain in popularity. Distraction osteogenesis has some theoretical advantages over 1-stage surgical cranial remodeling.3,4 Gradual expansion of the soft-tissue envelope allows greater gains in intracranial volume and minimizes relapse, and the bone flaps remain attached to dura mater, which reduces the risk of extradural abscess and supports postoperative bone repair and growth. FOA with distraction osteogenesis in particular has been widely used to achieve sufficient expansion of anterior cranium in syndromic craniosynostosis.4 Recently, posterior cranial vault distraction osteogenesis (PCVDO) has been advocated for syndromic craniosynostosis to greatly improve intracranial volume.5–7 Unfortunately, the posterior cranium in such patients is often thin, riddled with multiple bony defects (copper beaten skull), and subject to anomalous venous drainage, all of this jeopardizing the safety and efficiency of PCVDO and heightening postoperative complication rates.8 Multidirectional cranial distraction osteogenesis (MCDO) is a viable alternative to conventional distraction procedures.9 Herein, we report a case of syndromic craniosynostosis with anomalous venous drainage treated by MCDO.