Magge Keshav T, Magge Suresh N, Keating Robert F, Myseros John S, Boyajian Michael J, Sauerhammer Tina M, Rogers Gary F, Oh Albert K
From the Division of Plastic and Reconstructive Surgery and the Division of Neurosurgery, Children's National Medical Center, George Washington University.
J Craniofac Surg. 2014 Jul;25(4):1327-30. doi: 10.1097/SCS.0000000000000797.
Although the diagnosis of nonsyndromic single suture craniosynostosis (NSSC) can usually be made by clinical examination, computed tomography (CT) is still commonly used in preoperative evaluation. This practice has been questioned in light of recent studies that document a small, but measurable, increased risk of malignancy from CT-associated radiation. The purpose of this study was to examine whether preoperative CT for patients with NSSC provided clinically important information beyond confirmation of craniosynostosis. We performed a retrospective analysis of all patients with NSSC undergoing cranial vault remodeling at our center from March 1999 to March 2011. Only patients with complete preoperative CT scans available for review were included. Staff pediatric neurosurgeons were blinded to patient diagnosis and official radiology report, analyzed the CT images, and documented the site of synostosis and any other findings. Of the 231 patients, 80 met the inclusion criteria. Sites of synostosis included sagittal (51 patients), coronal (17 patients), metopic (11 patients), and frontosphenoidal (1 patient). Clinical diagnosis correlated with radiographic site of fusion in all patients except the patient with frontosphenoidal synostosis. Incidental findings were documented in more than 50% of the patients including prominent extra-axial cerebrospinal fluid (n = 36, 45%), ventriculomegaly (n = 5, 6.25%), choroid fissure cyst (n = 2), cavum septum pellucidum (n = 2), Chiari malformation (n = 1), and prominent perivascular space (clinically nonsignificant finding, n = 1). Incidental findings required additional follow-up or management in 5 patients (6.25%). Our findings support the use of preoperative imaging in this population to identify intracranial anomalies that cannot be discerned by clinical examination. Whereas many findings were not clinically important, some required additional attention.
虽然非综合征性单缝颅缝早闭（NSSC）通常可通过临床检查做出诊断，但计算机断层扫描（CT）仍常用于术前评估。鉴于最近的研究表明，CT相关辐射会增加患恶性肿瘤的风险，尽管风险较小但可测量，这种做法受到了质疑。本研究的目的是检查NSSC患者术前CT是否能提供除确认颅缝早闭之外的临床重要信息。我们对1999年3月至2011年3月在本中心接受颅盖重塑的所有NSSC患者进行了回顾性分析。仅纳入有完整术前CT扫描可供复查的患者。小儿神经外科医生在不知道患者诊断和官方放射学报告的情况下，分析CT图像，并记录颅缝早闭的部位和任何其他发现。在231例患者中，80例符合纳入标准。颅缝早闭的部位包括矢状缝（51例患者）、冠状缝（17例患者）、额缝（11例患者）和额蝶缝（1例患者）。除额蝶缝早闭患者外，所有患者的临床诊断与影像学融合部位均相符。超过50%的患者记录有偶然发现，包括蛛网膜下腔脑脊液增多（n = 36，45%）、脑室扩大（n = 5，6.25%）、脉络裂囊肿（n = 2）、透明隔腔（n = 2）、Chiari畸形（n = 1）和血管周围间隙增宽（临床无显著意义的发现，n = 1）。5例患者（6.25%）的偶然发现需要进一步随访或处理。我们的研究结果支持在该人群中使用术前影像学检查来识别临床检查无法发现的颅内异常。虽然许多发现并不具有临床重要性，但有些需要额外关注。
