Combined Dynamic Osteotomies for Craniosynostosis

Abstract

Background: In primary craniosynostosis, the premature fusion of one or more sutures prevents the perpendicular expansion of brain tissue (primary defect). Providing space for the brain to expand, the compensatory growth of unaffected sutures causes progressive skull deformation (secondary defect). Understanding the need to treat the osteogenic matrix responsible for the cranial vault’s shape was essential to develop a novel surgical concept known as dynamic osteotomy. It uses springs to activate stenotic sutures and trigger dura-mater distension while flexibilizing compensatory osseous defects via helicoid osteotomy (nautilus technique), allowing for efficient bone expansion and remodeling in craniosynostosis. Method: This case series describes patients with craniosynostosis treated with dynamic osteotomy utilizing structural transformation inductors such as springs and helicoid osteotomy (nautilus technique), operated on between July 2004 and January 2020 at a single center in Brazil. Result: Dynamic osteotomy longitudinally achieved stable osseous remodeling during growth period while maintaining good vitality and continuity of the osteotomized cranial vault. Conclusion: Dynamic osteotomy utilizing springs and nautilus technique, alone or in combination, is a successful treatment of craniosynostosis regardless of patient’s age.