DiRocco C, Caldarelli M, Ceddia A, Iannelli A, Velardi F
Minerva Pediatr. 1989 Aug;41(8):393-404.
One hundred-sixty-one cases of children operated on for craniostenosis in the first year of life at the Neurosurgical Department of the Catholic University of Rome in the period 1982-1986 are presented. The average age at diagnosis was 6 months and at operation 7.4 months. The patients considered in the present study were subdivided into two groups according to the prevalent involvement of sagittal suture or of the anterior sutural group (coronal metopic, spheno-frontal and spheno-palatine sutures). In fact, these two groups differ considerably not only in the characteristics of the pathological process of early fusion of the cranial sutures, but also in the technique required for surgical correction. Four children with premature fusion of all cranial sutures are considered separately. Congenital malformations of the bone structures or changes in ocular motility were presented in 7.9% of 63 patients with sagittal craniostenosis and in 14.7% of the group with premature fusion of the anterior cranial sutures. Surgical correction (linear craniectomies extended to the cranial base for the group with sagittal craniostenosis, craniectomies with advancement of the supraorbital margin and rotation of the bone operculum for the group with anterior craniostenosis) proved satisfactory in the great majority of cases. Postoperative morbidity was particularly low. Apart from postsurgical anaemia which required blood transfusion on the third day in 15.5% of operated patients, the only complications were transitory hyperpyretic states observed in 6.2% of cases. Only one child died for reasons related to the surgical procedure. The low postoperative mortality (0.6% of cases) and the low percentage of bone pathology recurrence (7.4%) compared with the results of other series involving older children, seem to indicate that the early surgical correction of bone malformations does not bear additional risk for the patient, permitting at the same time normal functional development of the brain and a more gradual morphological remodelling of the skull.
本文介绍了1982年至1986年期间在罗马天主教大学神经外科接受手术治疗的161例1岁以内患有颅骨狭窄症的儿童病例。诊断时的平均年龄为6个月，手术时的平均年龄为7.4个月。根据矢状缝或前缝组（冠状缝、额缝、蝶额缝和蝶腭缝）的主要受累情况，将本研究中的患者分为两组。事实上，这两组不仅在颅骨缝早期融合的病理过程特征上有很大差异，而且在手术矫正所需的技术上也有很大差异。4例所有颅骨缝过早融合的儿童单独考虑。在63例矢状缝颅骨狭窄症患者中，7.9%出现骨结构先天性畸形或眼球运动改变；在前颅缝过早融合组中，这一比例为14.7%。手术矫正（矢状缝颅骨狭窄症组行延伸至颅底的线性颅骨切除术，前颅缝狭窄症组行眶上缘推进和骨瓣旋转的颅骨切除术）在大多数病例中被证明是令人满意的。术后发病率特别低。除了15.5%的手术患者在术后第三天因贫血需要输血外，唯一的并发症是6.2%的病例出现短暂的高热状态。只有一名儿童因与手术相关的原因死亡。与其他涉及年龄较大儿童的系列研究结果相比，术后低死亡率（0.6%）和低骨病理复发率（7.4%）似乎表明，早期手术矫正骨骼畸形对患者没有额外风险，同时允许大脑正常功能发育和颅骨更渐进的形态重塑。
