Ranganathan Kavitha, Rampazzo Antonio, Hashmi Asra, Muraszko Karin, Strahle Jennifer, Vercler Christian J, Buchman Steven R
University of Michigan Health Systems, Ann Arbor.
Wayne State University, Detroit, MI.
J Craniofac Surg. 2018 Jan;29(1):36-39. doi: 10.1097/SCS.0000000000004026.
The necessity of imaging for patients with craniosynostosis is controversial. Lambdoid synostosis is known to be associated with additional anomalies, but the role of imaging in this setting has not been established. The purpose of this study was to evaluate the impact of preoperative imaging on intraoperative and postoperative management among patients undergoing operative intervention for lambdoid craniosynostosis.
A retrospective review of patients undergoing cranial vault remodeling for lambdoid craniosynostosis between January 2006 and 2014 was conducted. Patient demographics, age at computed tomography scan, age at surgery, results of the radiologic evaluation, operative technique, and modification of the diagnosis following the radiologic studies were analyzed. A pediatric neuroradiology and the surgical team interpreted the radiographs. The primary outcome was change in intraoperative or postoperative management based on imaging results.
A total of 11 patients were diagnosed with lambdoid synostosis. Of these patients, 81.8% had abnormalities on imaging relevant to operative planning. The most common anomalies were Chiari I malformation (45%) and venous anomalies of the posterior fossa (36%). Preoperative imaging altered the management of 9 (81.8%) patients. Closer follow-up was required for 6 patients (54%). Suboccipital decompression was performed in 4 patients (36%). Venous anomalies were found in 4 patients (36%). The diagnosis was changed from positional plagiocephaly to lambdoid synostosis in 2 patients (18%).
Given the frequency and significance of radiographic abnormalities in the setting of lamboid synostosis, preoperative imaging should be considered during the operative planning phase as it can affect postoperative and intraoperative management.
对于患有颅缝早闭的患者，影像学检查的必要性存在争议。已知人字缝早闭与其他异常情况相关，但影像学在此情况下的作用尚未明确。本研究的目的是评估术前影像学检查对接受人字缝颅缝早闭手术干预患者的术中及术后管理的影响。
对2006年1月至2014年期间接受颅盖重塑手术治疗人字缝颅缝早闭的患者进行回顾性研究。分析患者的人口统计学数据、计算机断层扫描时的年龄、手术时的年龄、放射学评估结果、手术技术以及放射学检查后诊断的改变。由儿科神经放射科医生和手术团队解读X线片。主要结局是基于影像学结果的术中或术后管理的改变。
共有11例患者被诊断为人字缝早闭。在这些患者中，81.8%的患者在与手术规划相关的影像学检查中有异常。最常见的异常是Chiari I畸形（45%）和后颅窝静脉异常（36%）。术前影像学检查改变了9例（81.8%）患者的管理。6例（54%）患者需要更密切的随访。4例（36%）患者进行了枕下减压。4例（36%）患者发现静脉异常。2例（18%）患者的诊断从位置性斜头畸形改为人字缝早闭。
鉴于人字缝早闭情况下放射学异常的频率和重要性，在手术规划阶段应考虑术前影像学检查，因为它会影响术后和术中管理。
