Expanding the Indications for the Modified Melbourne Technique: Posterior Vault Reconstruction for Secondary Craniosynostosis With a Persistent Occipital Defect After Encephalocele Repair.
Haven Ward, Gabriela Cendejas, William Cobb et al.
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Case in brief
A female infant with a prenatally diagnosed 10×12 cm occipital encephalocele, Chiari III malformation, posterior fossa hypoplasia, and mild ventriculomegaly underwent neonatal encephalocele resection and dural repair, followed by ventriculoperitoneal shunting. She later developed secondary sagittal craniosynostosis with a persistent large posterior calvarial defect. At 28 months, posterior vault remodeling using a modified Melbourne technique and split-thickness calvarial grafting reconstructed the 9×8 cm defect, expanded the posterior vault, restored cranial integrity, and corrected scaphocephaly.
What made this case unusual
The modified Melbourne technique, established for posterior vault expansion in sagittal synostosis, was applied to secondary sagittal craniosynostosis with a large persistent occipital defect after encephalocele repair and Chiari III malformation.
Diagnostic / clinical pearl
After repair of a large occipital encephalocele, persistent posterior calvarial defects and secondary craniosynostosis may require staged craniofacial reconstruction; assess both the vault deformity and the residual defect when planning reconstruction.