The symposium is co-organised by The Ann Conroy Trust, in association with Aesculap Academia.
The Ann Conroy Trust is Registered Charity No: 1165808.
We provide Support, Education and Research for patients living with Chiari Malformation, Syringomyelia and associated conditions.
F19 Posterior calvarial distraction for children with complex craniosynostosis, Chiari malformation type 1 and syringomyelia: a 10 year experience in a UK specialist centre.
Lo WB, Thant KZ, Kaderbhai J, Rodrigues D.
One-fifth of children with multi-suture and lambdoid synostosis have Chiari malformation type I (CM1). Posterior calvarial distraction is an effective method for increasing the intracranial volume in children with craniosynostosis. This study investigated the efficacy of this manoeuvre in posterior fossa volume expansion and treatment of CM1 with associated syringomyelia.
A ten-year retrospective study in a quaternary unit.
Sixteen children were identified, 8 males and 8 females, with a mean age of 5.1 years, range 8 months to 19 years. Fourteen children had pan-synostosis and two had lambdoid synostosis. Eight were syndromic. Ten patients had raised intracranial pressure. Four had a syrinx. Clinically, 9 patients improved and 7 remained stable. None deteriorated. The average distraction distance was 23mm (range 16-28mm). An osteotomy extending inferiorly to the torcula was associated with a larger posterior fossa antero-posterior distance increase (13mm vs 6mm, p=0.028). The average tonsillar descent improved from 9.3 to 6.0mm. Syrinx dimensions also improved, the superior-inferior extent decreasing from 203mm to 136mm and the anterior-posterior diameter reducing from 7.9mm to 3.1mm.
Cranial volume expansion following posterior calvarial distraction also includes posterior fossa volume expansion. This results in improvement of tonsillar descent and syrinx. Posterior calvarial distraction is a safe and effective first-line treatment for children with concurrent multi-suture craniosynostosis, CM1, and syringomyelia. These findings also add to existing hypotheses that Chiari malformation is not a condition as such but a manifestation of an insufficient intracranial volume.