da Silva Freitas Renato, de Freitas Azzolini Thais, Shin Joseph H, Persing John A
Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA.
J Craniofac Surg. 2010 Mar;21(2):411-3. doi: 10.1097/SCS.0b013e3181cfa7ad.
Craniosynostosis is the premature fusion of 1 or more of the cranial sutures, which causes an abnormal skull shape. The treatment is complex and requires surgical intervention for correction, between 3 and 12 months of age. The current standard for diagnosing craniosynostosis is to obtain a computed tomographic (CT) scan. However, recent studies have emphasized potential problems associated with ionizing radiation. The aim of this study was to evaluate the use of the preoperative CT scan, and its findings, and to define the value of these data.
This study is a retrospective analysis of 89 patients with craniosynostosis during the period between 1998 and 2007, who had CT using the Yale-New Haven Hospital computer system. Clinical findings such as age, sex, and diagnosis were recorded. All intraoperative abnormalities were noted. Preoperative CT scans were reevaluated for accuracy and completeness of diagnosis, cerebral anomalies, and other head and neck pathologic conditions.
Initially, 131 cases of nonsyndromic craniosynostosis were identified. Of these, we had access to CT evaluations in 89 patients. The mean age at the time of the surgery was 13 months, varying from 2 months to 18 years old. Most patients were males. The most common diagnoses were sagittal synostosis in 47 cases; unilateral coronal, 16; and metopic, 15. In most patients, the CT scan demonstrated the same diagnosis as the clinical examination-derived diagnosis. However, 6 patients had an incomplete diagnosis or misdiagnosis. In addition, 3 cases of prominence of the subarachnoid space, 2 cases of cerebral atrophy, 1 case of subarachnoid tumor, and 1 deformational dysplasia of encephalon were identified. Other minor additional diagnoses were 5 cases of fluid in the middle ear and antrum of mastoid, 2 cases of cysts in the maxilla, and 1 case of an associated cervical lymphatic tumor.
The advantage of CT use is greater accuracy in diagnosis, less potential for inappropriate surgery, and, as an ancillary effect, a more complete and timely assessment of congenital anomalies so that more appropriate referrals can be made. Low-dose (pediatric) radiation CT still seems to have a place in the examination of a patient with skull deformity and potential craniosynostosis.
颅缝早闭是一条或多条颅缝过早融合，导致颅骨形状异常。治疗较为复杂，需要在3至12个月大时进行手术干预以矫正。目前诊断颅缝早闭的标准是进行计算机断层扫描（CT）。然而，最近的研究强调了与电离辐射相关的潜在问题。本研究的目的是评估术前CT扫描的使用及其结果，并确定这些数据的价值。
本研究是对1998年至2007年间89例颅缝早闭患者的回顾性分析，这些患者使用耶鲁 - 纽黑文医院计算机系统进行了CT检查。记录年龄、性别和诊断等临床发现。记录所有术中异常情况。对术前CT扫描进行重新评估，以确定诊断的准确性和完整性、脑异常情况以及其他头颈部病理状况。
最初，共识别出131例非综合征性颅缝早闭病例。其中，我们获得了89例患者的CT评估结果。手术时的平均年龄为13个月，年龄范围从2个月至18岁。大多数患者为男性。最常见的诊断为矢状缝早闭47例；单侧冠状缝早闭16例；额缝早闭15例。在大多数患者中，CT扫描显示的诊断与临床检查得出的诊断相同。然而，有6例患者诊断不完整或误诊。此外，还发现3例蛛网膜下腔增宽、2例脑萎缩、1例蛛网膜下腔肿瘤和1例脑发育异常。其他次要的额外诊断包括5例中耳和乳突窦积液、2例上颌囊肿以及1例相关的颈部淋巴瘤。
使用CT的优势在于诊断准确性更高、不适当手术的可能性更小，并且作为附带作用，可以更全面、及时地评估先天性异常情况，从而进行更合适的转诊。低剂量（儿科）辐射CT在检查有颅骨畸形及潜在颅缝早闭的患者中似乎仍有一席之地。
