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Total Calvarial Reconstruction for Increased Intracranial Pressure and Chiari Malformation

This procedure is a total calvarial vault expansion to correct pansynostosis in a three-year-old child. Total calvarial reconstruction is an open procedure that consists of removing bone flaps with an osteotome, outfracturing the skull bone edges with a rongeur to allow for future expansion, shaving down the bone flap inner table with a Hudson brace to create a bone mush for packing the interosseus spaces, and modifying then reattaching the bone flaps with absorbable plates and screws. This patient is status post craniofacial reconstruction for earlier sagittal synostosis. Second operations are uncommon after correction of single-suture synostosis, so this more aggressive technique represents an attempt to definitively correct the calvarial deformity and resolve the signs and symptoms of the attendant intracranial hypertension. Indications for surgery include cosmetic and neurologic concerns, here including a Chiari malformation and cervicothoracic syrinx. This educational video is related to a current research project of the Children’s National Medical Center Division of Neurosurgery regarding single-suture craniosynostosis and the factors that place children at risk for surgical recidivism in the setting of intracranial hypertension.

Kelsey Cobourn, BS – Children’s National Medical Center Division of Neurosurgery and Georgetown University

Owen Ayers – Children’s National Medical Center Division of Neurosurgery and Princeton University

Deki Tsering, MS – Children’s National Medical Center Division of Neurosurgery

Gary Rogers, MD, JD, MBA, MPH – Children’s National Medical Center Division of Plastic and Reconstructive Surgery and George Washington University School of Medicine

Robert Keating, MD – Children’s National Medical Center Division of Neurosurgery and George Washington University School of Medicine (corresponding author)

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There are no conflicts of interest to disclose.
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