A posterior vault expansion operation is a type of operation used to enlarge the space within the skull to allow the brain to grow and develop.
The skull is made up of several ‘plates’ of bone which, when we are born, are not tightly joined together. The seams where the plates join are called ‘sutures’. As we grow older, the sutures gradually fuse (stick) together, usually after all head growth has finished. When a child has craniosynostosis, the sutures fuse before birth. It can affect one suture or several. When one or more sutures fuse too soon, the space inside the skull cannot expand as a child grows. This can put pressure on the brain (raised intracranial pressure) which can have significant long term effects on visual function and neurological development.
There are two main types of posterior vault expansion operation – the main difference between them is the method used to expand the space inside the skull. The most common method used at GOSH is to insert metal springs that gradually widen a gap made between the skull bones, which encourage new bone to grow in between the two cut surfaces. Another method sometimes used at GOSH is a bone graft – this is bone taken from elsewhere in the skull and fixed in place to fill the gap.
Posterior vault expansion surgery tends to be carried out to treat raised pressure within the skull (intracranial pressure) when it occurs. This can happen at any age throughout childhood although usually before 10 years of age. Raised intracranial pressure can occur in the following types of craniosynostosis:
- Crouzon syndrome
- Pfeiffer syndrome
- Apert syndrome
- Saethre-Chotzen syndrome
- Muenke syndrome
- Bicoronal craniosynostosis
Posterior vault expansion may be the only form of treatment needed or it may be just one in a series of operations carried out throughout childhood and adolescence.
Getting ready for the operation
The night before surgery
On the day of surgery
What anaesthetic is given?
What does the operation involve?
Are there any risks?
Are there any alternatives to this operation?
What happens after the operation?
Follow up appointments
Removal of springs
What is the outlook for children who have had posterior vault expansion surgery?
Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.