Cornelissen Martijn J, Loudon Sjoukje E, van Doorn Frida E C, Muller Rogier P M, van Veelen Marie-Lise C, Mathijssen Irene M J
Rotterdam, The Netherlands.
From the Departments of Plastic and Reconstructive Surgery and Hand Surgery, Ophthalmology, Child and Adolescent Psychiatry, and Neurosurgery, Erasmus University Medical Center.
Plast Reconstr Surg. 2017 Jan;139(1):97e-104e. doi: 10.1097/PRS.0000000000002866.
Trigonocephaly is caused by metopic suture synostosis. It is treated by fronto-orbital remodeling, not only to correct the deformity but also to prevent intracranial hypertension, the reported prevalence in trigonocephaly of which ranges from 0 to 33 percent. To support treatment analysis and the design of a treatment protocol for intracranial hypertension in these patients, the authors wished to more accurately quantify the prevalence of preoperative and postoperative intracranial hypertension in a large patient cohort.
The authors included all trigonocephaly patients born between 2001 and 2013 who had all been operated on at a single center. During follow-up, the presence of intracranial hypertension was evaluated by funduscopy, and occipitofrontal head circumference was measured. The occipitofrontal head circumference curve was analyzed and its relation to intracranial hypertension assessed.
In total, 262 patients with trigonocephaly were included. Before surgery, 1.9 percent of them had intracranial hypertension; after surgery, 1.5 percent did (mean age at last follow-up, 4.9 years). Sixteen of 176 patients (9 percent) had occipitofrontal head circumference curve stagnation, which was significantly related to intracranial hypertension (p = 0.001, Fisher's exact test).
Intracranial hypertension occurs only sporadically in patients with metopic suture synostosis. Occipitofrontal head circumference measurement should take a prominent place in the postoperative follow-up of metopic suture synostosis patients; stagnation of the occipitofrontal head circumference requires additional screening for intracranial hypertension.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
三角头畸形由额缝早闭引起。通过额眶重塑进行治疗，不仅是为了矫正畸形，还为了预防颅内高压，据报道三角头畸形患者中颅内高压的患病率在0%至33%之间。为了支持对这些患者颅内高压的治疗分析和治疗方案设计，作者希望更准确地量化一大组患者术前和术后颅内高压的患病率。
作者纳入了2001年至2013年出生且均在单一中心接受手术的所有三角头畸形患者。在随访期间，通过眼底镜检查评估颅内高压的存在情况，并测量枕额头围。分析枕额头围曲线并评估其与颅内高压的关系。
总共纳入了262例三角头畸形患者。术前，其中1.9%的患者有颅内高压；术后，有1.5%的患者有颅内高压（最后一次随访时的平均年龄为4.9岁）。176例患者中有16例（9%）出现枕额头围曲线停滞，这与颅内高压显著相关（p = 0.001，Fisher精确检验）。
颅内高压仅偶发于额缝早闭患者。枕额头围测量在额缝早闭患者术后随访中应占据重要地位；枕额头围停滞需要额外筛查颅内高压。
临床问题/证据水平：治疗性，IV级。
