LoPresti Melissa, Buchanan Edward P, Shah Veeral, Hadley Caroline M, Monson Laura A, Lam Sandi
Department of Neurosurgery/Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Department of Plastic Surgery/Pediatric Plastic Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
J Pediatr Neurosci. 2017 Apr-Jun;12(2):199-202. doi: 10.4103/jpn.JPN_15_17.
We report a case of surgical management of Crouzon syndrome with multisuture craniosynostosis presenting with increased intracranial pressure (ICP) manifesting with chronic papilledema without ventriculomegaly. A 12-month-old boy had complete resolution of papilledema after posterior cranial vault distraction followed by staged fronto-orbital advancement. Expansion of the cranial vault with posterior distraction osteogenesis posed an elegant treatment, obviating ventriculoperitoneal shunt placement for cerebrospinal fluid (CSF) diversion. Strategies for the management of elevated ICP without ventriculomegaly in craniosynostosis include CSF shunting and cranial vault expansion. Posterior calvarial vault distraction associated with resolved papilledema has not been previously reported. Addressing the craniocephalic disproportion for this child with chronic papilledema, without ventriculomegaly, allowed the possibility of shunt freedom.
我们报告了一例Crouzon综合征合并多缝颅缝早闭的手术治疗病例，该患儿表现为颅内压（ICP）升高，伴有慢性视乳头水肿，但无脑室扩大。一名12个月大的男孩在进行后颅穹窿牵张术，随后分期进行额眶前移术后，视乳头水肿完全消退。通过后颅牵张成骨进行颅穹窿扩张提供了一种有效的治疗方法，避免了为脑脊液（CSF）分流而进行脑室腹腔分流术。在颅缝早闭中，对于无脑室扩大的ICP升高的管理策略包括CSF分流和颅穹窿扩张。此前尚未有后颅穹窿牵张与视乳头水肿消退相关的报道。针对这名患有慢性视乳头水肿且无脑室扩大的儿童的颅面比例失调问题进行治疗，使得无需进行分流成为可能。
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