Philadelphia, Pa. From the Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia.
Plast Reconstr Surg. 2013 Jun;131(6):1367-1375. doi: 10.1097/PRS.0b013e31828bd541.
Posterior cranial vault distraction osteogenesis has replaced fronto-orbital advancement in some centers as the first-line treatment in patients with syndromic craniosynostosis. Despite this fact, little has been written about its craniometric effects on children with syndromic craniosynostosis.
A retrospective review of all patients who underwent posterior distraction was performed. Patient demographic, perioperative data, and preoperative/postoperative computed tomographic scans were reviewed. Volumetric and craniometric indices were calculated and measured using commercial three-dimensional imaging software.
From 2008 to 2012, 22 patients underwent posterior vault distraction osteogenesis for suspected intracranial hypertension or severe turribrachicephaly. In 13 patients, this was the first cranial vault procedure performed, whereas eight had previous fronto-orbital advancement and one had parieto-occipital reshaping. Half of patients underwent posterior cranial vault distraction osteogenesis before age 1 year; the average age at surgery was 2.3 years (range, 0.3 to 14.1 years) and distraction length averaged 27.3 mm (range, 19 to 35 mm). Average length of surgery was 2.9 hours (range, 1.6 to 3.8 hours), and average blood loss was 400 ml (range, 200 to 600 ml). Total treatment length was 91 days (range, 48 to 147 days). Distraction length averaged 27.3 mm (range, 19 to 35 mm). Intracranial volume increase averaged 21.5 percent (range, 7.5 to 70.0 percent; p<0.0001) and 28.4 percent (range, 10.8 to 66.0 percent; p=0.01) in the subset of patients younger than 1 year. Posterior cranial height increased 12.2 percent (range, 0 to 35 percent; p=0.002), and basofrontal angle decrease averaged 3.9 percent (range, 0 to 12 percent; p=0.003), indicating a decrease in cranial height trajectory and improvement in frontal bossing.
Posterior cranial vault distraction is a safe and effective operation that may lower risk of intracranial hypertension and abnormal skull morphology. Interestingly, cranial morphological benefits were seen both anteriorly and posteriorly.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
在后颅窝颅骨牵张成骨术已取代了额眶前移术，成为颅缝早闭综合征患者的一线治疗方法。尽管如此，对于患有颅缝早闭综合征的儿童，后颅窝颅骨牵张术对其颅面形态的影响却鲜有报道。
对所有接受后颅窝牵张术的患者进行回顾性研究。分析患者的人口统计学资料、围手术期数据和术前术后的 CT 扫描。使用商业三维成像软件计算和测量体积和颅面测量指标。
2008 年至 2012 年，22 例患者因颅内压增高或严重舟状头畸形而接受后颅窝颅骨牵张术。其中 13 例患者为首次行颅盖手术，8 例患者曾行额眶前移术，1 例患者行顶枕重塑术。半数患者在 1 岁前接受后颅窝颅骨牵张术；手术时的平均年龄为 2.3 岁（0.3-14.1 岁），牵张长度平均为 27.3mm（19-35mm）。手术平均时间为 2.9 小时（1.6-3.8 小时），平均失血量为 400ml（200-600ml）。总治疗时间为 91 天（48-147 天）。牵张长度平均为 27.3mm（19-35mm）。颅内体积增加平均为 21.5%（7.5-70.0%；p<0.0001），1 岁以下患者颅内体积增加平均为 28.4%（10.8-66.0%；p=0.01）。后颅窝高度增加 12.2%（0-35%；p=0.002），额底角减小平均 3.9%（0-12%；p=0.003），提示颅高轨迹降低，额部前突改善。
后颅窝颅骨牵张是一种安全有效的手术方法，可降低颅内压增高和颅面形态异常的风险。有趣的是，颅面形态的改善在前部和后部均可见。
临床问题/证据水平：治疗性，IV 级。
