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Posterior Vault Distraction

Posterior Vault Distraction

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Preoperative Considerations

Consent:

Anesthesia/Positioning:

  • Prone position with head elevated above heart
  • Subcutaneous local anesthetic with epinephrine
  • Eye Pads
  • Trans nasal intubation preferred
  • Two venous lines

Other:

Armamentarium:

Technique

  • 1. Patient intubated under general anesthesia in the prone position
  • 2. Bircoronal weave incision marked
  • 3. Supraperiosteal dissection to minimize bleeding
  • 4. Periosteum incised at site of osteotomies and osteotomy line marked on bone
  • 6. Ball drill used to make burr holes around the planned osteotomy
  • 7. Dural dissectors utilized to separate calvarium and dura between burr holes
  • 8. Craniotomy performed with craniotomy or piezotome and bone rongeurs
  • 9. Two to four distractors placed in parallel direction
  • 10. Skin closure
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Postoperative Considerations

Immediate:

  • Patient transported to PACU or ICU with extubation as soon as possible.
  • Careful patient positioning to avoid pressure ulcers.

Follow Up:

  • Two to four week activation period with lateral x-rays to monitor progression
  • Distractor devices remain in place for one to six months post-activation for ossification period

Operative Note

Coding

Diagnosis Codes: 

  • Q75.00 Craniosynostosis unspecified
  • Q75.01 Sagittal craniosynostosis
  • Q75.02 Coronal craniosynostosis
  • Q75.03 Metopic craniosynostosis
  • Q75.04 Lamboid craniosynostosis
  • Q75.04 Multi-suture craniosynostosis
  • Q75.08 Other single-suture craniosynostosis

Procedure Code: 

  • 61550 Craniectomy for craniosynostosis, single cranial suture
  • 61552 Craniectomy for craniosynostosis, multiple cranial sutures

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