Massimi Luca, Tamburrini Gianpiero, Caldarelli Massimo, Di Rocco Concezio
Pediatrc Neurosurgery, Catholic University Medical School, Rome, Italy.
Childs Nerv Syst. 2007 Dec;23(12):1389-401. doi: 10.1007/s00381-007-0472-9. Epub 2007 Sep 18.
Several surgical techniques have been proposed for the correction of sagittal craniosynostosis. Extensive procedures seem to ensure the most stable long-term results and are more indicated in the older age group. Mini-invasive approaches are particularly useful in the very young infant as they are associated with a minor surgical risk. Furthermore, they are weighted by a minor cosmetic impact related to a less extended surgical scar.
Data of the last 94 consecutively operated on scaphocephalic patients have been reviewed to verify the effectiveness of a personal limited-invasive approach based on four to six short linear scalp incisions vs the traditional bicoronal skin flap. The patients have been divided in two groups: (1) the control group (2000-2002): 45 children, operated on by means of a traditional bicoronal skin incision, and (2) the study group (2002-2004): 49 children, treated through four to six linear scalp incisions. The patients' variables were comparable. The results were evaluated in terms of duration of the surgical procedure, estimated blood loss (EBL), transfusion risk, postoperative complication rate, length of hospital stay, and postoperative cephalic index and cosmetic outcome as perceived by the patients' families.
No significant differences between the two groups were found about the early and the long-term surgical results; however, about one third of the subjects of the control group complained about the visibility of the surgical scar. In the study group, a significant reduction in the duration of the operation (p < 0.0001), postoperative hospital stay (p < 0.0001), EBL (p = 0.011), transfusion risk (p = 0.018), and complication rate (p = 0.016) was observed.
The current trend in the management of scaphocephaly is to favor simplified surgical procedures to be performed in the younger ages prevalently. The technique here presented allows achieving a stable long-term cranial reshaping, even when performed in the very young patient. The technique can be utilized also in older subjects with results comparable to those of more extensive surgical procedures. This less invasive technique is weighted by minor complication rates and minor impact of the surgical scar.
已经提出了几种用于矫正矢状缝早闭的手术技术。广泛的手术似乎能确保最稳定的长期效果，并且在年龄较大的人群中更适用。微创方法对非常小的婴儿特别有用，因为它们的手术风险较小。此外，与不太广泛的手术疤痕相关的较小美容影响也减轻了其负担。
回顾了最近连续接受手术的94例舟状头畸形患者的数据，以验证基于四到六个短线性头皮切口的个人有限侵入性方法与传统双冠状皮瓣相比的有效性。患者被分为两组：（1）对照组（2000 - 2002年）：45名儿童，通过传统双冠状皮肤切口进行手术；（2）研究组（2002 - 2004年）：49名儿童，通过四到六个线性头皮切口进行治疗。患者的变量具有可比性。根据手术时间、估计失血量（EBL）、输血风险、术后并发症发生率、住院时间以及患者家属所感知的术后头指数和美容效果对结果进行评估。
两组在早期和长期手术结果方面未发现显著差异；然而，对照组约三分之一的受试者抱怨手术疤痕明显可见。在研究组中，观察到手术时间（p < 0.0001）、术后住院时间（p < 0.0001）、EBL（p = 0.011）、输血风险（p = 0.018）和并发症发生率（p = 0.016）均有显著降低。
目前舟状头畸形治疗的趋势是倾向于在较小年龄时普遍采用简化的手术程序。这里介绍的技术即使在非常年幼的患者中进行，也能实现稳定的长期颅骨重塑。该技术也可用于年龄较大的患者，其结果与更广泛的手术程序相当。这种侵入性较小的技术并发症发生率较低，手术疤痕影响较小。
