Morota Nobuhito, Ogiwara Hideki, Kaneko Tsuyoshi
Division of Neurosurgery, National Medical Center for Children and Mothers, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, Japan, 157-8535.
Childs Nerv Syst. 2012 Sep;28(9):1353-8. doi: 10.1007/s00381-012-1810-0. Epub 2012 Aug 8.
The authors described their surgical technique for scaphocephaly in relatively older infants who are 5 months old or over. The technique is a kind of hybrid of distraction osteogenesis utilizing skull expanders and a traditional cranial reconstruction procedure.
The surgery usually consists of four procedures. The first is to make strip craniotomy over the superior sagittal sinus (SSS) from the major fontanelle to the minor one. The second is the occipital craniotomy for the occipital bossing. The occipital bone flap undergoes barrel stave osteotomy and is repositioned later. The third is placement of skull expander for distraction osteogenesis. Bidirectional small strip craniotomy is made along the coronal and lambdoid sutures, then transverse cutting is added to make a hinge point near the base of the parietal bone. Two to three skull expanders are placed crossing the SSS. The last procedure is radial-oriented osteotomy on the dorsal end of frontal bone to meet the elevated, expanded parietal bone. Skull expansion starts within a week with 5 mm/week base up to 20 to 30 mm. Exposed shafts of the expander are cut at the end of skull expansion.
Process of osteogenesis is followed at an outpatient clinic, and the expanders are removed 4 to 6 months later after confirming the sufficient ossification. An advantage of our procedure is that maximum skull expansion is possible with minimum regression after distraction osteogenesis in the long term. Limited craniotomy enables limited blood loss. The skin trouble caused by stretching can be avoided. No postoperative helmet is required. A disadvantage is that the procedure leaves a foreign body on the skull for several months and requires additional surgery for removal.
作者描述了他们针对5个月及以上相对较大婴儿的舟状头畸形的手术技术。该技术是一种利用颅骨扩张器的牵张成骨与传统颅骨重建手术的混合方法。
手术通常包括四个步骤。第一步是从大囟门到小囟门在矢状窦上方进行条状颅骨切开术。第二步是针对枕部隆突进行枕骨颅骨切开术。枕骨骨瓣进行桶状板截骨术，随后重新定位。第三步是放置颅骨扩张器进行牵张成骨。沿冠状缝和人字缝进行双向小条状颅骨切开术，然后增加横向切口以在顶骨底部附近形成一个铰链点。两到三个颅骨扩张器交叉放置在矢状窦上方。最后一步是在额骨背侧端进行放射状截骨术，以与抬高、扩张的顶骨相接。颅骨扩张在一周内开始，以每周5毫米的速度进行，直至达到20至30毫米。在颅骨扩张结束时切除扩张器暴露的杆部。
在门诊诊所观察成骨过程，在确认充分骨化后4至6个月取出扩张器。我们手术的一个优点是，从长期来看，牵张成骨后能以最小的回缩实现最大程度的颅骨扩张。有限的颅骨切开术可减少失血量。可以避免因拉伸引起的皮肤问题。术后无需佩戴头盔。一个缺点是该手术会在颅骨上留下异物数月，并且需要额外的手术来取出。
