Yarbrough Chester K, Smyth Matthew D, Holekamp Terrence F, Ranalli Nathan J, Huang Andrew H, Patel Kamlesh B, Kane Alex A, Woo Albert S
From the *Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri; †Departments of Neurosurgery and Pediatrics, University of Florida College of Medicine, Jacksonville, Florida; ‡Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri; and §Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Craniofac Surg. 2014 Jan;25(1):119-23. doi: 10.1097/SCS.0b013e3182a75102.
Craniosynostosis causes significant cranial deformity in the pediatric population. Open and endoscopic-assisted surgeries have led to increasingly successful management of this condition. Following surgical reconstruction, subsequent development of postnatal synostosis of previously patent sutures have been described and noted to be most frequently associated with multisuture synostosis patients with syndromic diagnoses. Very rarely, postsurgical new sutural fusion has been identified in nonsyndromic patients who initially present with isolated single-suture synostosis. The purpose of this study was to evaluate the incidence of new synostosis among patients who had undergone craniosynostosis reconstruction with either the open or endoscopic technique.
Patients undergoing open and endoscopic surgery for nonsyndromic craniosynostosis were reviewed. Preoperative and postoperative imaging and clinical information were reviewed, and cases showing progressive cranial deformity were identified.
Three (2.1%) of 145 patients undergoing open craniosynostosis surgery and 2 (1.7%) of 121 patients undergoing endoscopic surgery developed delayed fusion of an additional suture during follow-up. This was identified at a median of 16.4 months after initial surgery in the open group and 15.25 months after surgery in the endoscopic group. In patients undergoing open surgery, each patient developed new sagittal synostosis after initial presentation of coronal synostosis in 1 patient and metopic synostosis in 2 patients. In patients undergoing endoscopic surgery, each patient developed new coronal synostosis after sagittal repair.
Management of craniosynostosis has evolved over time with increasing availability of effective and safe treatments. During long-term follow-up, a small number of patients may develop premature closure of a different suture that did not undergo surgical manipulation. In our case, series, we identified 3 patients undergoing open surgery and 2 patients undergoing endoscopic surgery for nonsyndromic, single-suture craniosynostosis. This finding supports the necessity of long-term clinical follow-up and the utility of delayed imaging when clinical suspicion indicates.
颅缝早闭在儿童群体中会导致严重的颅骨畸形。开放性手术和内镜辅助手术对这种病症的治疗愈发成功。在手术重建后，先前开放的颅缝出现产后颅缝早闭的情况已有报道，且发现其在患有综合征诊断的多颅缝早闭患者中最为常见。在最初表现为孤立单颅缝早闭的非综合征患者中，术后新的颅缝融合非常罕见。本研究的目的是评估采用开放性或内镜技术进行颅缝早闭重建的患者中新颅缝早闭的发生率。
对接受开放性和内镜手术治疗非综合征性颅缝早闭的患者进行回顾。对术前和术后的影像学及临床信息进行审查，并确定出现进行性颅骨畸形的病例。
145例行开放性颅缝早闭手术的患者中有3例（2.1%），121例行内镜手术的患者中有2例（1.7%）在随访期间出现了额外颅缝的延迟融合。在开放性手术组中，这一情况在初次手术后的中位时间为16.4个月时被发现，在内镜手术组中为术后15.25个月。在接受开放性手术的患者中，1例患者在最初出现冠状缝早闭后出现了新的矢状缝早闭，2例患者出现了额缝早闭。在接受内镜手术的患者中，每例患者在矢状缝修复后出现了新的冠状缝早闭。
随着有效和安全治疗方法的日益增多，颅缝早闭的治疗方法也在不断发展。在长期随访中，少数患者可能会出现未接受手术操作的不同颅缝过早闭合的情况。在我们的病例系列中，我们确定了3例接受开放性手术和2例接受内镜手术治疗非综合征性单颅缝早闭的患者。这一发现支持了长期临床随访的必要性以及在临床怀疑时有延迟成像的实用性。
