Melbourne, Victoria, Australia From the Department of Plastic and Maxillofacial Surgery and the Department of Neurosurgery, Royal Children's Hospital Melbourne; and the Department of Paediatrics, University of Melbourne.
Plast Reconstr Surg. 2013 Oct;132(4):602e-610e. doi: 10.1097/PRS.0b013e31829f4b3d.
Total vault reconstruction addresses all phenotypic aspects of scaphocephaly. The clinical implications of remodeling across open cranial sutures, however, remain unclear. The purpose of this study was to assess patency of unaffected sutures following total vault remodeling for isolated sagittal synostosis.
The authors reviewed routine postoperative computed tomographic scans of patients who underwent total vault remodeling for isolated sagittal synostosis between 2004 and 2008. Sutural patency was scored by a single reviewer as follows: 0 = closed, 1 = partial, and 2 = open. Individual suture scores were tallied for a total sutural patency score. Computed tomographic scans were stratified by postoperative time and craniofacial surgeon.
Forty-two patients met the inclusion criteria. Individual sutural closure rates were 42.6, 38.3, 74.5, and 74.5 percent for right coronal, left coronal, right lambdoidal, and left lambdoidal sutures, respectively. Lambdoidal sutures had a significantly higher rate of closure than coronal sutures (OR(Closure), 4.3; 95 percent CI, 2.3 to 8.0; p < 0.001); lambdoidal patency significantly changed over time (χ2 = 9.9, p = 0.04). Across craniofacial surgeons, coronal and lambdoidal patency were equivalent. The total sutural patency score did not significantly correlate with postoperative time, surgical age, preoperative cephalic index, or craniofacial surgeon.
Total vault remodeling for isolated sagittal synostosis results in a high degree of secondary craniosynostosis. Lambdoidal sutures are especially prone to closure, with their patency diminishing over time. At this time, radiographic fusion of adjacent sutures following surgery has not been related to any difference in head shape.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
全颅盖重建可解决颅缝早闭的所有表型方面的问题。然而，开放颅缝重塑后的影响仍不清楚。本研究的目的是评估单纯矢状缝早闭行全颅盖重建后未受累颅缝的通畅性。
作者回顾了 2004 年至 2008 年间行全颅盖重建术治疗单纯矢状缝早闭的患者的常规术后 CT 扫描。由一位阅片者对颅缝通畅性进行评分，评分标准如下：0=关闭，1=部分开放，2=开放。对各颅缝的评分进行汇总，得到总的颅缝通畅性评分。根据术后时间和颅面外科医生对 CT 扫描进行分层。
42 例患者符合纳入标准。右侧冠状缝、左侧冠状缝、右侧人字缝和左侧人字缝的单独闭合率分别为 42.6%、38.3%、74.5%和 74.5%。人字缝的闭合率明显高于冠状缝（OR（闭合），4.3；95%CI，2.3 至 8.0；p<0.001）；人字缝的通畅性随时间显著变化（χ2=9.9，p=0.04）。不同颅面外科医生的冠状缝和人字缝的通畅性无显著差异。总的颅缝通畅性评分与术后时间、手术年龄、术前头围指数或颅面外科医生均无显著相关性。
单纯矢状缝早闭行全颅盖重建后会导致继发性颅缝早闭的发生率较高。人字缝尤其容易闭合，其通畅性随时间而降低。目前，手术后相邻颅缝的影像学融合与头型无差异相关。
临床问题/证据水平：治疗，IV。
