Comparative Outcomes and Morphology Following Surgical Reconstruction for Mercedes Benz Craniosynostosis

Objective Mercedes Benz craniosynostosis is a multisutural pattern characterized by posterior vault constriction due to fusion of sagittal and bilateral lambdoid sutures. Middle-posterior cranial vault remodeling (MPCVR) and posterior cranial vault distraction osteogenesis (PCVDO) are commonly used to address posterior vault deficiency, but comparative data in this population remain limited. This study evaluates perioperative, volumetric, and craniometric outcomes following MPCVR and PCVDO in Mercedes Benz craniosynostosis. Design A retrospective review of computed tomographic images before and 1 year after surgery. Setting Tertiary pediatric institution. Patients, Participants Eighteen patients with Mercedes Benz craniosynostosis. Interventions MPCVR or PCVDO. Main Outcome Measure(s) Demographics, operative characteristics, and craniometric measurements. Results Eighteen patients were included; 50% underwent MPCVR, 27.8% PCVDO, and 22.2% strip craniectomy. PCVDO demonstrated a significantly shorter operative time than MPCVR ( P = .008) and trended toward lower blood loss. MPCVR produced a 50.8% increase in total intracranial volume, with the greatest expansion in the posterior vault (60.6%). PCVDO resulted in a 28.6% total volume increase, with posterior expansion (21.5%). Craniometric outcomes showed MPCVR achieved larger gains in width (20.4%), middle height (19.3%), and posterior height (14.7%), whereas PCVDO produced greater increases in circumference (11.22%), cranial length (15.28%), and vertex angle (18.99%). Both procedures improved skull base angles, with larger reductions observed in the PCVDO group. Conclusions MPCVR and PCVDO exhibit distinct expansion patterns in Mercedes Benz craniosynostosis. MPCVR offers broad volumetric remodeling, while PCVDO provides greater longitudinal expansion. These findings support individualized selection of posterior vault techniques for this rare craniosynostosis subtype.