Total Cranial Vault Remodeling Using Multidirectional Cranial Distraction Osteogenesis in Craniosynostosis

Background: Multidirectional cranial distraction osteogenesis (MCDO) was previously developed by the authors for craniosynostosis correction but was limited to the anterior two-thirds of the cranium, leaving occipital deformities unaddressed. To overcome this limitation, we refined the technique by creating an external frame that encompasses the entire cranial circumference, enabling multidirectional expansion of the skull. Methods: Twenty-three patients with craniosynostosis underwent total cranial vault remodeling using MCDO between 2016 and 2021. Mean age at surgery was 30.1 months (range, 7–98 mo). Cranial morphology was assessed using 3-dimensional computed tomography preoperatively, immediately after device removal, and at 1 year postoperatively. Results: All patients achieved satisfactory correction and expansion. Mean transfusion volume was 48.2 mL/kg. The distraction phase lasted 6–11 days (mean, 9.0 d), and the consolidation phase, 16–57 days (mean, 41.1 d). One patient had cerebrospinal fluid leakage requiring reoperation; 3 had anchor-pin loosening requiring early device removal without affecting outcomes. In scaphocephaly (cephalic index [CI] < 70; n = 4), CI improved from 68.1 ± 3.0 to 81.7 ± 3.7 ( P < 0.001). In brachycephaly (CI > 100; n = 3), CI decreased from 120.9 ± 4.8 to 105.0 ± 5.9 ( P = 0.006). In intracranial volume expansion cases (n = 12), volume increased from 1221 ± 285 mL to 1496 ± 332 mL ( P < 0.001). Conclusions: Total cranial vault remodeling with MCDO enables comprehensive 3-dimensional correction of craniosynostosis, addressing diverse morphological phenotypes. This technique represents a promising alternative to conventional reconstruction.