Posterior cranial vault distraction osteogenesis (PCVDO) is a well‑established surgical technique used to increase intracranial volume and correct skull deformities in pediatric patients with craniosynostosis. Reported complication rates, however, have varied widely across institutions—until now.
Dr. Mohammed A. Fouda
Dr. Mohammed A. Fouda, Fellow in Pediatric Neurosurgical Innovations at Weill Cornell Medicine, has conducted a systematic review offering the most comprehensive analysis to date of perioperative complications associated with (PCVDO) in children with craniosynostosis. The study, co‑authored by Dr. Caitlin Hoffman, Associate Professor of Neurological Surgery in pediatrics and Director of the Craniosynostosis Program at Weill Cornell Medicine, and Dr. Thomas Imahiyerobo, Associate Professor of Surgery and Director of Cleft and Craniofacial Surgery at Columbia University Irving Medical Center, was published in the Journal of Neurosurgery: Pediatrics in December 2025.
Comprehensive Review of Surgical Outcomes
Dr. Fouda and colleagues conducted a systematic review and proportional meta‑analysis of 33 peer‑reviewed studies published between 2009 and 2025, focusing on pediatric patients younger than 18 years. They found a pooled overall complication rate of 26.3 percent. Infection and wound‑related complications were most common at 10.4 percent, followed by cerebrospinal fluid leakage (6.7 percent) and device‑related issues (6.0 percent). Unplanned reoperation occurred in 9.9 percent of patients.
“By pooling data from institutions around the world, we were able to better quantify the risks associated with this operation and identify factors that influence outcomes,” Dr. Hoffman said. “This information is critical for surgical planning and for counseling families.”
Age and Timing Influence Risk
Younger patient age was associated with higher rates of cerebrospinal fluid leakage and premature device removal. Shorter latency periods, the time between device placement and the initiation of distraction, were also linked to increased complication rates.
“These findings highlight that both patient age and distraction protocol play an important role in complication risk,” Dr. Fouda said. “They reinforce the importance of individualized treatment planning, particularly for very young children.”
Collaborative Leadership in Pediatric Craniofacial Care
As Co‑Director of the Multidisciplinary Craniofacial Program and Director of Craniosynostosis Surgery at Weill Cornell Medicine, Dr. Hoffman brings extensive expertise in complex craniofacial care. Dr. Imahiyerobo, Section Chief of Pediatric Plastic and Reconstructive Surgery at Columbia University, is a key collaborator in the bi-campus craniosynostosis program.
Together, the team works across institutions to advance evidence‑based care and improve outcomes for children with craniosynostosis.
By consolidating clinical outcomes across institutions, this study provides pediatric neurosurgeons with an essential evidence-based benchmark for counseling families and refining surgical approaches. It reinforces the department’s commitment to advancing safe, innovative care for children with complex craniofacial conditions.
Advancing Innovation in Craniofacial Surgery
In addition to leading this study, Dr. Fouda recently received a second year of support from the Daedalus Fund for Innovation to advance the Magnet Actuated Cranial (M.A.C.) Distraction System. The technology is designed to eliminate external activation ports and improve outcomes by reducing hardware failures, infections, and the burden of care for families.
The Daedalus Fund, managed by Enterprise Innovation, provides critical gap funding to translate early‑stage discoveries into commercial readiness through rigorous review by industry‑experienced evaluators.
Learn more about pediatric neurosurgery at Weill Cornell Medicine:
https://neurosurgery.weillcornell.org/service/pediatric-neurosurgery