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Neurocranial suture transplantation in synostosis from experiment to clinical application

Neurocranial suture transplantation in synostosis from experiment to clinical application. Growth of the neurocranium . Hunter, 1798 Brash, 1934. Bair, 1954. Growth stimulus - mechanical tension theory. - biological signalling theory. Endosteal layer Meningeal layer.

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Neurocranial suture transplantation in synostosis from experiment to clinical application

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  1. Neurocranial suture transplantation in synostosis from experiment to clinical application

  2. Growth of the neurocranium Hunter, 1798 Brash, 1934 Bair, 1954

  3. Growth stimulus • - mechanical tension theory - biological signalling theory

  4. Endosteal layer Meningeal layer

  5. Suture development periosteum dura mater Growth factors TGF-beta, FGF, BMP Transcription factors Msx2, Twist, Runx2 Fusion or synostosis

  6. Radical remodelling and suture transplantation Stricker & Raphael, 1993

  7. but:

  8. 10 days postoperatively

  9. 5 months postoperatively

  10. 15 months postoperatively

  11. 14 days postoperatively 5 months postoperatively 15 months postoperatively Cleft Palate Craniofacial J 38: 533-537, 2001

  12. Hypothesis A neurocranial suture autograft will, when shielded from dura, be incorporated into the calvarium and grow.

  13. 2,5 cm

  14. Postnatal day 9 Postnatal day 90

  15. 5 does • 6 siblings from each nest • 10 “sham”-treated • 10 with left coronal suture blocked at foetal age • of 25 days • 9 with blocked suture, and coronal suture • transplantation from right to left, with • interpositioning of platina foil on day 9 • postnatally • All with titanium “markers”

  16. Measurements • day 9 • day 90 • = doubled skull length

  17. Results mm, SD Child Nerv Syst 19: 211-216, 2003

  18. Conclusion A suture autograft grow when shielded from direct dural signals

  19. (non-decalcified 30m slice, van Stevenels blue & Von Giesons picrofuchsin staining X40)

  20. A J Craniofacial Surgery 12: 547-554, 2001

  21. 10 mm 4.5 mm 10 mm 13.5 mm 11.5 mm 12.5 mm 11 months 10 days

  22. 12 months difference

  23. prior to surgery 2 j,7m postoperatively 8j postoperatively J Cranio-Maxillo-Facial Surgery 31:1-7, 2003

  24. brachycephaly

  25. 4.35 4.54 9-2-2004 06-05-2004 15-03-2005

  26. 20-05-2005 1.77 2.16 09-11-2005 02-07-2007

  27. 1.24 1.83 12-02-2007 26-03-2007 09-07-2007 no mechanical stimulus !

  28. Prospectives • is a biomechanical stimulus (fixation and early incorporation) necessary as part of the concept? Animal research • is radical remodelling still required? Multicenter clinical audit

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