ArticleChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2025
Surgical management of raised ICP in craniosynostosis: experience-based selection of posterior vault expansion techniques.
Article in Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate outcomes of three posterior vault expansion (PVE) techniques in children with craniosynostosis and confirmed raised intracranial pressure (ICP) and propose a practical framework to guide surgical technique selection based on patient-specific characteristics.
methodsWe retrospectively analyzed 116 pediatric patients who underwent their first PVE for confirmed raised ICP between January 2018 and January 2024 at a tertiary craniofacial center. Patients underwent one of three surgical techniques: static remodeling (PVE-S), spring-assisted posterior vault expansion-classic (SAPVE-C), or spring-assisted posterior vault expansion-vertical vector (SAPVE-VV). Outcomes included functional improvement (fundoscopy, VEPs, symptoms, Chiari I), volumetric change in intracranial volume (ICV), operative time, transfusion rates, complications, and reoperation-free survival. Analyses were stratified by age and syndromic diagnosis.
resultsAll techniques significantly improved functional markers, with complete resolution of papilledema and normalized VEPs in over 80% of patients. SAPVE-C and SAPVE-VV achieved greater increases in ICV compared to PVE-S (18.9% and 17.2% vs. 12.7%, respectively). SAPVE-C was fastest (mean 138 min), followed by SAPVE-VV (174.7 min) and PVE-S (214.5 min). Transfusion rates were highest in SAPVE-C (64.1%) and SAPVE-VV (60.5%). Reoperation occurred in 11.2% of patients, with significantly higher risk in those operated before age 1 (p = 0.04). Age-stratified outcomes revealed SAPVE-C achieved the highest volumetric gain in < 2 years, while SAPVE-VV was most effective in older patients.
conclusionsEach PVE technique offers distinct advantages. SAPVE-C is optimal for syndromic infants, SAPVE-VV provides volumetric control in complex cases across ages, and PVE-S remains effective for older, non-syndromic patients. A tailored, age- and diagnosis-based selection strategy is essential for optimizing outcomes in craniosynostosis-related raised ICP.
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