A comparative analysis of intracranial volume increase in the syndromic skull by either fronto-orbital advancement or posterior advancement
Ivo Gwanmesia MD, Rafael Couto MD, Gaby Doumit MD, Frank Papay MD
The Cleveland Clinic
Presenter: Ivo Gwanmesia
All the work for the project was done by the fellow
Director Name: Dr Frank Papay MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
TITLE: A COMPARATIVE ANALYSIS OF INTRACRANIAL VOLUME INCREASE IN THE SYNDROMIC SKULL BY EITHER FRONTO-ORBITAL ADVANCEMENT OR POSTERIOR ADVANCEMENT
Background: Patients with craniofacial syndromes commonly present with synostosis of multiple sutures. This often causes raised intracranial pressure. Fronto-orbital advancement has traditionally been the treatment of choice. More recently, posterior advancement/distraction is being used in many centers. There are however no studies that directly compare intracranial volume increases by both techniques.
Aims and Objectives: The primary objective of this ongoing study is to determine which of the 2 methods is more effective at increasing intracranial volume. A secondary objective is to determine what level of the posterior craniotomy is most effective at increasing intracranial volume.
Methods: Pre-surgical skull CT scans of 30 patients with Apert, Crouzon and Pfeiffer syndrome are utilized for the study. Using a computer software, virtual surgery is performed on the computer. Intracranial volume is determined following fronto-orbital advancement. Similarly, intracranial volume after posterior advancement is determined following restoration of the bifrontal craniotomy and supra-orbital bandeau to their native positions.
To determine which posterior craniotomy was most effective at increasing intracranial volume, posterior craniotomies are carried out at the level of the posterior occipital protuberance, 1cm below that level and 1cm above the foramen magnum.
Results: Initial results suggest that the posterior advancement produces a significantly greater volume increase compared to fronto-orbital advancement (p<0.05)
Conclusion: This project should enable us to determine which of the 2 techniques is most effective at increasing intracranial volume.