Rottgers S Alex, Lohani Subash, Proctor Mark R
Department of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida; and.
Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts.
J Neurosurg Pediatr. 2016 Sep;18(3):281-6. doi: 10.3171/2016.2.PEDS15693. Epub 2016 May 20.
OBJECTIVE Historically, bilateral frontoorbital advancement (FOA) has been the keystone for treatment of turribrachycephaly caused by bilateral coronal synostosis. Early endoscopic suturectomy has become a popular technique for treatment of single-suture synostosis, with acceptable results and minimal perioperative morbidity. Boston Children's Hospital has adopted this method of treating early-presenting cases of bilateral coronal synostosis. METHODS A retrospective review of patients with bilateral coronal craniosynostosis who were treated with endoscopic suturectomy between 2005 and 2012 was completed. Patients were operated on between 1 and 4 months of age. Hospital records were reviewed for perioperative morbidity, length of stay, head circumference and cephalic indices, and the need for further surgery. RESULTS Eighteen patients were identified, 8 males and 10 females, with a mean age at surgery of 2.6 months (range 1-4 months). Nine patients had syndromic craniosynostosis. The mean duration of surgery was 73.3 minutes (range 50-93 minutes). The mean blood loss was 40 ml (range 20-100 ml), and 2 patients needed a blood transfusion. The mean duration of hospital stay was 1.2 days (range 1-2 days). There was 1 major complication in the form of a CSF leak. The mean follow-up was 37 months (range 6-102 months). Eleven percent of nonsyndromic patients required a subsequent FOA; 55.6% of syndromic patients underwent FOA. The head circumference percentiles and cephalic indices improved significantly. CONCLUSIONS Early endoscopic suturectomy successfully treats the majority of patients with bilateral coronal synostosis, and affords a short procedure time, a brief hospital stay, and an expedited recovery. Close follow-up is needed to detect patients who will require a secondary FOA due to progressive suture fusion or resynostosis of the released coronal sutures.
目的 从历史上看，双侧额眶前移术（FOA）一直是治疗双侧冠状缝早闭所致短头畸形的关键方法。早期内镜下缝扎切除术已成为治疗单缝早闭的常用技术，效果良好且围手术期发病率极低。波士顿儿童医院已采用这种方法治疗早期出现的双侧冠状缝早闭病例。方法 对2005年至2012年间接受内镜下缝扎切除术治疗的双侧冠状缝早闭患者进行回顾性研究。患者手术年龄在1至4个月之间。查阅医院记录，了解围手术期发病率、住院时间、头围和头指数，以及是否需要进一步手术。结果 共确定18例患者，男性8例，女性10例，手术平均年龄为2.6个月（范围1至4个月）。9例患者患有综合征性颅缝早闭。平均手术时间为73.3分钟（范围50至93分钟）。平均失血量为40毫升（范围20至100毫升），2例患者需要输血。平均住院时间为1.2天（范围1至2天）。出现1例主要并发症，表现为脑脊液漏。平均随访37个月（范围6至102个月）。11%的非综合征性患者需要后续进行FOA；55.6%的综合征性患者接受了FOA。头围百分位数和头指数显著改善。结论 早期内镜下缝扎切除术成功治疗了大多数双侧冠状缝早闭患者，手术时间短，住院时间短，恢复快。需要密切随访，以发现因释放的冠状缝渐进性融合或重新融合而需要二次FOA的患者。
