van Veelen Marie-Lise C, Mihajlović Dalibor, Dammers Ruben, Lingsma Hester, van Adrichem Leon N A, Mathijssen Irene M J
Departments of 1 Neurosurgery.
Public Health, and.
J Neurosurg Pediatr. 2015 Jul;16(1):86-93. doi: 10.3171/2014.12.PEDS14260. Epub 2015 Apr 24.
OBJECT Various techniques to correct sagittal synostosis have been described. The authors of this study assess the results of 2 techniques for late complete cranial remodeling and test the hypothesis that adding a widening bridge would improve outcome. METHODS In this retrospective study, the authors evaluated patients with nonsyndromic sagittal synostosis-those who underwent frontobiparietal remodeling (FBR) and those who underwent modified FBR (MFBR) involving the introduction of a bony bridge to increase the width of the skull. Outcomes for both groups are described in terms of the aesthetic results assessed on photographs and any changes in the cranial index (CI) and head circumference over time, the presence of papilledema, and complaints of headache. The effect of the surgical technique on CI and head circumference over time was assessed using linear regression analysis, with adjustment for preoperative CI and head circumference. RESULTS Sixty-nine patients with isolated sagittal synostosis were included in this study: 35 underwent MFBR and 34 underwent the original technique of FBR. The mean follow-up period was 7 years. In the 1st year after surgery, mean CI improved by 9% in the FBR group and by 12% in the MFBR group. One year after surgery, CI in the MFBR group was on average 4.7% higher than that in the FBR group (p < 0.001). During follow-up, CI decreased in both groups; however, at all time points CI was significantly higher in the MFBR group than in the FBR group. The impact of surgical technique on CI was less important than the impact of preoperative CI (R(2)= 0.26 vs 0.54), and this applied at all time points during follow-up. Head circumference declined during follow-up in both groups. It was influenced by preoperative head circumference, but not by surgical technique. Aesthetic outcome, prevalence of headache (42%), and papilledema (7%) were comparable in both groups. CONCLUSIONS Adding a widening bridge to late complete remodeling significantly improved CI and helped to prevent CI from decreasing in the long term. This addition did not affect the head circumference growth curve. Despite a mean head circumference remaining at +1 SD, patients continued to develop papilledema postoperatively (7%).
目的 已描述了多种矫正矢状缝早闭的技术。本研究的作者评估了两种晚期完全颅骨重塑技术的结果，并检验了增加一个加宽桥接结构会改善治疗效果的假设。方法 在这项回顾性研究中，作者评估了非综合征性矢状缝早闭患者，即接受额顶骨重塑（FBR）的患者和接受改良FBR（MFBR）（包括引入骨桥以增加颅骨宽度）的患者。两组的治疗效果通过照片评估的美学结果、颅骨指数（CI）和头围随时间的任何变化、视乳头水肿的存在情况以及头痛主诉来描述。使用线性回归分析评估手术技术对CI和头围随时间的影响，并对术前CI和头围进行校正。结果 本研究纳入了69例孤立性矢状缝早闭患者：35例行MFBR，34例行原始的FBR技术。平均随访期为7年。术后第1年，FBR组的平均CI提高了9%，MFBR组提高了12%。术后1年，MFBR组的CI平均比FBR组高4.7%（p<0.001）。在随访期间，两组的CI均下降；然而，在所有时间点，MFBR组的CI均显著高于FBR组。手术技术对CI的影响不如术前CI的影响重要（R²=0.26对0.54），且在随访期间的所有时间点均如此。两组随访期间头围均下降。它受术前头围的影响，但不受手术技术的影响。两组的美学效果、头痛患病率（42%）和视乳头水肿患病率（7%）相当。结论 在晚期完全重塑中增加一个加宽桥接结构可显著改善CI，并有助于长期防止CI下降。这一增加并未影响头围生长曲线。尽管平均头围仍保持在+1标准差，但患者术后仍会出现视乳头水肿（7%）。
