Protzenko Cervante Tatiana, Arnaud Eric, Brunelle Francis, Di Rocco Federico
Departments of 1 Pediatric Neurosurgery and.
Neuroradiology, Necker Enfants Malades Hospital, APHP, Paris, France.
J Neurosurg Pediatr. 2016 May;17(5):589-94. doi: 10.3171/2015.8.PEDS15117. Epub 2016 Jan 8.
OBJECTIVE The sagittal suture is usually considered an external anatomical landmark, indicating the location of the superior sagittal sinus (SSS) for surgical approaches. Children with unilateral coronal synostosis (UCS) often present with an important deviation of the sagittal suture. Because these patients usually undergo frontal reconstruction or even endoscope-assisted minimally invasive procedures, it is imperative to know the location of the SSS. The aim of this investigation was to study the anatomical relationship between the SSS and the sagittal suture in children with anterior plagiocephaly. METHODS The authors retrospectively studied the relationship between the sagittal sinus and the sagittal suture at 5 points: nasion, midpoint nasion-bregma, bregma, midpoint bregma-lambda, and lambda. The study analyzed CT scans of 50 children with UCS admitted to the craniofacial unit of Necker Enfants Malades Hospital between March 2006 and March 2013 and compared them with 50 control children with no evidence of craniosynostosis, bone disease, or genetic syndromes. The authors also analyzed the presence of extracerebral fluid collection and ventricular asymmetry in children with UCS. RESULTS Fifty-six percent of patients had anterior right UCS and 44% had left-sided UCS. Type I UCS was seen in 1 patient, Type IIA in 20 patients, Type IIB in 20 patients, and Type III in 9 patients. The authors found that the nasion is usually deviated to the ipsilateral side of the synostosis, the bregma contralaterally, and the lambda ipsilaterally. The gap distances between the reference point and the SSS were 0-7.3 mm (mean 1.4 mm) at the nasion; 0-16.7 mm (mean 3.8 mm) at the midpoint nasion-bregma; 0-12 mm (mean 5.8 mm) at the bregma; 0-9.5 mm (mean 3 mm) at the midpoint bregma-lambda; and 0-11.6 mm (mean 5.5 mm) at the lambda. Conversely, a discrepancy of more than 1 mm between the SSS and the position of the suture was found only in 7 control cases (14%). Of patients with UCS, 38% presented with an extracerebral fluid collection contralateral to the fused coronal suture. Fifty-two percent had a ventricular asymmetry, which was characterized by reduced ventricular volume ipsilateral to the synostosis in all but 1 patient. CONCLUSIONS In this study, the SSS was usually deviated contralaterally to the closed coronal suture. It tended to be in the midline of the cranial vault and could be projected virtually along an imaginary line passing through the midline of the cranial base. The authors recommend a distance of 37 mm from the sagittal suture as a safety margin during surgery.
矢状缝通常被视为一个外部解剖标志，用于在手术入路时指示上矢状窦（SSS）的位置。单侧冠状缝早闭（UCS）患儿常出现矢状缝的重要偏移。由于这些患者通常要进行额部重建甚至内镜辅助的微创手术，因此了解SSS的位置至关重要。本研究的目的是探讨前斜头畸形患儿中SSS与矢状缝之间的解剖关系。
作者回顾性研究了矢状窦与矢状缝在5个点的关系：鼻根点、鼻根点与前囟中点、前囟点、前囟点与枕骨隆突中点、枕骨隆突点。该研究分析了2006年3月至2013年3月期间入住内克尔儿童医院颅面外科的50例UCS患儿的CT扫描结果，并将其与50例无颅缝早闭、骨病或遗传综合征证据的对照患儿进行比较。作者还分析了UCS患儿脑外积液和脑室不对称的情况。
56%的患者为右侧前UCS，44%为左侧UCS。1例患者为I型UCS，20例为IIA型，20例为IIB型，9例为III型。作者发现，鼻根点通常向缝早闭的同侧偏移，前囟点向对侧偏移，枕骨隆突点向同侧偏移。鼻根点与SSS之间的间隙距离为0 - 7.3 mm（平均1.4 mm）；鼻根点与前囟中点之间为0 - 16.7 mm（平均3.8 mm）；前囟点处为0 - 12 mm（平均5.8 mm）；前囟点与枕骨隆突中点之间为0 - 9.5 mm（平均3 mm）；枕骨隆突点处为0 - 11.6 mm（平均5.5 mm）。相反，仅在7例对照病例（14%）中发现SSS与缝位置之间的差异超过1 mm。在UCS患者中，38%在融合冠状缝的对侧出现脑外积液。52%有脑室不对称，除1例患者外，所有患者的特征均为缝早闭同侧脑室体积减小。
在本研究中，SSS通常向闭合冠状缝的对侧偏移。它倾向于位于颅顶的中线，实际上可沿一条穿过颅底中线的假想线投影。作者建议在手术期间距矢状缝37 mm的距离作为安全 margin 。 （注：原文中“safety margin”未明确给出准确中文释义）
