Jimenez David F, Barone Constance M, Cartwright Cathy C, Baker Lynette
Department of Neurological Surgery, Center for Craniofacial Disorders, University of Missouri Hospital and Clinics, Columbia, Missouri 65212, USA.
Pediatrics. 2002 Jul;110(1 Pt 1):97-104. doi: 10.1542/peds.110.1.97.
To assess the safety, efficacy, and results of the early treatment of infants with craniosynostosis using minimally invasive endoscopic strip craniectomies and postoperative helmet molding therapy.
A total of 100 patients with documented diagnosis of craniosynostosis were prospectively studied and treated with endoscopic strip craniectomies. A total of 106 stenosed sutures were operated on with the following distribution: 61 sagittal, 23 coronal, 18 metopic, and 4 lambdoid sutures. Sixty-three patients were treated under 16 weeks of age. After surgery, all patients were treated with custom-made molding helmets for up to 7 months. Follow-up ranged between 4 months and 50 months.
All patients underwent the surgical procedures successfully and without complications. The mean surgical operative time was 52.7 minutes. The mean estimated blood loss was 26.2 mL; only 1 patient underwent intraoperative blood transfusion, and 10 patients had a non- life-threatening postoperative blood transfusion. All but 3 patients were discharged on the first postoperative day. There were no infections, dural sinus tears, cerebrospinal fluid leaks, or neurologic injuries, and there were no significant complications related to the use of helmet therapy. Most patients have achieved or are in the process of reaching normalization of their craniofacial deformities.
The results indicate that the early treatment of craniosynostosis with minimally invasive endoscopic strip craniectomies is a safe, efficacious, and valuable therapeutic alternative to the current extensive surgical treatment modalities. The significantly less blood loss, need for blood transfusions, and length of stay and decreased costs make this procedure an excellent early option for treating infants who present with craniosynostosis.
评估采用微创内镜下条带颅骨切除术及术后头盔塑形疗法对婴儿颅缝早闭进行早期治疗的安全性、有效性及治疗效果。
对100例经确诊的颅缝早闭患者进行前瞻性研究，并采用内镜下条带颅骨切除术进行治疗。共对106条狭窄缝线进行了手术，分布如下：矢状缝61条、冠状缝23条、额缝18条、人字缝4条。63例患者在16周龄以下接受治疗。术后，所有患者均佩戴定制塑形头盔，佩戴时间长达7个月。随访时间为4个月至50个月。
所有患者均成功接受手术，无并发症发生。平均手术时间为52.7分钟。平均估计失血量为26.2毫升；仅1例患者术中输血，10例患者术后接受了无生命危险的输血。除3例患者外，所有患者均在术后第一天出院。无感染、硬脑膜窦撕裂、脑脊液漏或神经损伤，且与头盔治疗使用相关的无明显并发症。大多数患者已实现或正在实现颅面畸形的正常化。
结果表明，采用微创内镜下条带颅骨切除术对颅缝早闭进行早期治疗是一种安全、有效且有价值的治疗选择，可替代目前广泛应用的手术治疗方式。出血量显著减少、输血需求、住院时间及成本降低，使该手术成为治疗颅缝早闭婴儿的极佳早期选择。
