Apert syndrome: neurosurgical outcomes and complications following posterior vault distraction osteogenesis

Cassio Eduardo Raposo-Amaral; Marcela Vincenzi-Lemes; Mateus L Medeiros; Cesar Augusto Raposo-Amaral; Enrico Ghizoni

doi:10.1007/s00381-024-06436-2

Apert syndrome: neurosurgical outcomes and complications following posterior vault distraction osteogenesis

Childs Nerv Syst. 2024 May 3. doi: 10.1007/s00381-024-06436-2. Online ahead of print.

Authors

Cassio Eduardo Raposo-Amaral^{1

2}, Marcela Vincenzi-Lemes³, Mateus L Medeiros³, Cesar Augusto Raposo-Amaral³, Enrico Ghizoni^{3

4}

Affiliations

¹ Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo, 13084-880, Brazil. cassioraposo@hotmail.com.
² Department of Neurology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil. cassioraposo@hotmail.com.
³ Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo, 13084-880, Brazil.
⁴ Department of Neurology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.

PMID: 38700706
DOI: 10.1007/s00381-024-06436-2

Abstract

Purpose: Posterior vault distraction osteogenesis (PVDO) has been utilized during the past 15 years to treat a variety of clinical features commonly presented by patients with Apert syndrome. The objective of this study is to determine the efficacy of PVDO in addressing both elevated intracranial pressure (ICP) and ectopia of the cerebellar tonsils (ECT) in young Apert patients. In addition, we aimed to determine the prevalence of hydrocephalus in Apert syndrome patients who underwent PVDO.

Methods: A retrospective study was made with a cohort of 40 consecutive patients with syndromic craniosynostosis (SC), previously diagnosed with Apert syndrome, who underwent PVDO between 2012 and 2022, and thereafter received at least 1 year of follow-up care. Demographic data and diagnosis, along with surgical and outcome data, were verified using medical records, clinical photographs, radiologic examination, and interviews with the parents of all cohort patients.

Results: The average patient age when PVDO was performed was 12.91 ± 10 months. The average posterior advancement distance achieved per patient was 22.68 ± 5.26 mm. The average hospital stay per patient was 3.56 ± 2.44 days. The average absolute and relative blood transfusion volumes were 98.47 ml and 17.63 ml/kg, respectively. Although five patients (14%) presented ECT preoperatively, this condition was completely resolved by PVDO in three of these five patients. One of the three patients whose ECT had completely resolved presented syringomyelia postoperatively, requiring subsequent extra dural foramen magnum decompression. All of the remaining four patients were asymptomatic for ECT for at least 1 year of follow-up, and none of these four patients required any additional treatments to address ECT. Two patients presented hydrocephalus requiring ventriculoperitoneal shunt placement.

Conclusions: This study demonstrates that PVDO both reduces diagnosed elevated ICP symptoms and is partially effective in treating ECT in Apert syndrome patients. Hydrocephalus in Apert syndrome is an uncommon feature. The effectiveness of PVDO in addressing hydrocephalus is uncertain.

Keywords: Apert syndrome; Craniofacial dysostosis; Syndromic craniosynostosis.