Distraction osteogenesis for surgical treatment of craniosynostosis: a systematic review.

Background: Distraction osteogenesis (DO) has been proposed as an alternative to cranial remodeling surgery (CRS) for craniosynostosis, but technique descriptions and outcome analyses are limited to small case series. This review summarizes operative characteristics and outcomes of DO for craniosynostosis and presents data comparing DO to CRS. Methods: A systematic review of the literature was undertaken. Descriptive analysis, operative technical data, outcomes, or post-operative complications of DO for craniosynostosis were included. Results: A total of 1,325 citations were reviewed yielding 53 articles and 880 children who underwent DO for craniosynostosis. Conventional distraction plates (standard DO) were used in 754 (86%) patients, whereas spring-assisted DO was used with the remaining 126 (14%) patients. Conventional and Spring DO was reported to successfully treat the primary condition 98% of the time. However, suboptimal results were reported in 11 (1.3%) patients. There were no stated relapse or revision surgeries. Minor complications were reported in 19.5% (n= 172) of cases, while major complications were rare, occurring in 3.5% (n=31) of cases, and included 2 reported deaths. Absolute operative times and blood loss were marginally greater for CRS cases, but not statistically significant. Conclusion: As a technique for cranial vault remodeling, DO is effective in treating craniosynostosis. No statistical differences were found with respect to operative time, blood loss, need for transfusion, or intensive care resources compared to CRS. Outcome studies with longer follow up periods specifically investigating cost, relapse, and reoperation rates are necessary to effectively compare this treatment modality as an alternative to CRS. (C)2016American Society of Plastic Surgeons

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