Experience with resorbable sonic pins for the attachment of distraction devices in posterior cranial vault distraction operations

Abstract

Background Distraction techniques are effective methods for the treatment of craniosynostoses when a significant gain of an intracranial volume is required. However, this technique raises some challenges at different stages of the treatment. While installing the distractors in patients with thin calvarial bone, there is a risk of dural damage from the titanium screws. The need for wide exposure of the devices and the screws during removal causes soft tissue damage and bleeding. Objective This study aimed to evaluate sonic pin use in the distraction procedures. Methods Resorbable sonic pins were used in 11 consecutive posterior cranial vault distraction procedures to attach distraction devices to the calvarial bone. Results This method allowed for a less traumatic and faster removal of the devices without the risk of leaving foreign bodies in the wound. In three out of 11 cases on follow-up, displacement of proximal distractor footplate and partial relapse of distraction were detected. Though there was a smaller volume increase in these patients, all of them benefited clinically from the PCVD and did not require reoperations. Conclusions This method allows a strong and stable attachment of the distractor devices to the cranial vault bones with a reduced risk of dural tears due to the screws. It also allows for easier and less traumatic device removal.

Posterior Cranial Distraction in Craniosynostosis: A Systematic Review of the Literature

“…10,11 Eight studies computed the average intracranial volume gain using preoperative and postoperative computed tomography scans. 8,11,12,14,18,[20][21][22] In those studies, the average volume gain was 253.2 cm 3 . The average volume gain per mm of distraction was 9.8 cm 3 .…”

“…Various strategies have been employed to decrease this risk, including using resorbable material in the epidural space to act as a barrier between the dura and the screws, 5,35 using self-drilling screws, 17 using the shortest screws possible, 6 and using resorbable pins instead of titanium screws. 14 No comparative study has been published to establish the effectiveness of any of these maneuvers. Overall, we found that PCD has a complication rate of 32.2%, which is higher than calvarial vault remodeling (5-11%), 36 spring-assisted cranioplasty (7.4%) 37 and minimally-invasive suturectomy and helmet therapy (3.5%).…”

“…Sixteen studies representing 307 subjects detailed postoperative complications. [8][9][10][11][12][13][14][15][16][17][18][19][20][21]23,25 The overall complication rate in those studies was 32.2% (Figure 2). The most common complication was surgical-site infection (10.7%), followed by hardware failure/fracture/dislodgement (8.5%), delayed wound healing (6.2%), persistent cerebrospinal fluid leak (5.5%), significant hemorrhage (0.7%), meningitis (0.3%) and death (0.3%).…”

Distraction osteogenesis in craniosynostosis

“…In younger patients or instances of thin calvarium, the device can be stabilized with footplates of mesh covering the bone to reduce stress from pin fixation [28]. Resorbable fixation systems such as ultrasound-activated pins, heat-activated pins, sonic pins and conventional resorbable screws have been experimented with to obviate the need for a second procedure [28,29]. Sonic pins are accepted as reliable but may resorb too quickly for ossification during consolidation [28].…”

Posterior vault distraction technique: how I do it

“…At least four self-drilling, self-tapering titanium mini screws are used on each footplate. Additionally, biodegradable pins SonicWeld ® can be used to fix the devices replacing part or all of the titanium screws [ 2 , 13 ]. When inserting the screws, the dura is protected from perforation by placing dissector between the bone and the dura.…”