Al-Jabri Talal, Eccles Simon
From the Department of Craniofacial Surgery, Imperial College London, Chelsea and Westminster Hospital, London, England.
J Craniofac Surg. 2014 Jul;25(4):1266-72. doi: 10.1097/SCS.0000000000000961.
Unilateral lambdoid synostosis is considered to be the rarest form of craniosynostosis. Since the introduction of the Sudden Infant Death Syndrome "back to sleep" campaign, the incidence of unilateral lambdoid synostosis was reportedly increasing. This was proven to be false and a consequence of non-specific diagnostic criteria in excluding suture fusion from deformational changes. This, in turn, led to ambiguity in the literature in terms of features and surgical correction in the 1980s to 1990s.
We aimed to navigate the literature for true studies of unilateral lambdoid synostosis and examine the results of their surgical corrections.
A systematic review with a defined search strategy.
A search on MEDLINE and Google Scholar using strategy: (Unilateral AND ((lambdoid* AND Synostosis) OR (lambdoid* AND Craniosynostosis) OR (Posterior AND Plagiocephaly)) AND (Surgery).
Articles were reviewed, and data were compiled into tables for analysis.
Seventeen studies were included in this review. A total of 188 patients with unilateral lambdoid synostosis were identified. No patients had major complications (venous sinus tear, neurologic injury, or cerebrospinal fluid leakage). Facial asymmetry was widely noted, and only limited improvement was achieved postoperatively. Auricular displacement was variable and often persisted despite surgery. Neurodevelopment did not deteriorate postoperatively and even improved in several patients. Endoscopic techniques revealed shorter periods of hospitalization, reduced mean estimated blood loss, and no blood transfusion requirements. The timing of surgery at 6 to 12 months was found to be the optimal balance in preventing deterioration in neurodevelopment and allowing favorable cranial growth and morphology.
The current evidence is difficult to navigate because of deformational plagiocephaly being misdiagnosed as unilateral lambdoid synostosis. Despite this, we present the only systematic review of all truly identifiable cases of unilateral lambdoid synostosis. Long-term quantitative studies are required to assess the benefits of the various surgical procedures.
单侧人字缝早闭被认为是颅缝早闭最罕见的形式。自从婴儿猝死综合征“仰睡”运动开展以来，据报道单侧人字缝早闭的发病率在上升。事实证明这是错误的，这是在将缝线融合排除在变形性改变之外时采用非特异性诊断标准的结果。这反过来又导致20世纪80年代至90年代的文献在特征和手术矫正方面存在模糊性。
我们旨在梳理有关单侧人字缝早闭的真实研究文献，并检查其手术矫正结果。
采用明确搜索策略的系统综述。
使用以下策略在MEDLINE和谷歌学术上进行搜索：（单侧 AND（（人字缝* AND 早闭）或（人字缝* AND 颅缝早闭）或（后部 AND 斜头畸形））AND（手术）。
对文章进行综述，并将数据整理成表格进行分析。
本综述纳入了17项研究。共确定了188例单侧人字缝早闭患者。没有患者出现严重并发症（静脉窦撕裂、神经损伤或脑脊液漏）。面部不对称普遍存在，术后仅取得有限改善。耳廓移位情况不一，即使手术后也常常持续存在。神经发育术后没有恶化，甚至有几名患者有所改善。内镜技术显示住院时间缩短、平均估计失血量减少且无需输血。发现6至12个月时进行手术是预防神经发育恶化以及实现良好颅骨生长和形态的最佳平衡。
由于变形性斜头畸形被误诊为单侧人字缝早闭，目前的证据难以梳理。尽管如此，我们呈现了对所有真正可识别的单侧人字缝早闭病例的唯一系统综述。需要进行长期定量研究来评估各种手术方法的益处。
