Abouhassan William, Chao John Kuang, Murthy Ananth S
Department of Plastic Surgery, The Ohio State University, Columbus.
Northeast Ohio Medical University, Rootstown.
J Craniofac Surg. 2018 Jul;29(5):e492-e497. doi: 10.1097/SCS.0000000000004507.
Craniosynostosis is an uncommon complication after shunting procedures for congenital hydrocephalus. We report a case of a child with myelomeningocele and normocephaly at the time of birth. She underwent ventricular shunting for Chiari malformation and hydrocephalus at 3 days of age. An immediate postoperative CT scan confirmed all sutures were open. Serial CT scans document an open metopic suture at 2 months, closed metopic suture at 5 months, and trigonocephaly at 11 months with concomitant slit ventricle syndrome, and collapsed lateral and third ventricles.
An Ovid MEDLINE search within the dates of 1948 through 2017, using the keywords "synostosis AND shunt" was carried out. A tabulation of all patients and their respective synostosis patterns were recorded.
We identified 8 case series and 2 case reports during 43 years (1966-2017). Seventy-eight patients with 79 suture synostosis patterns were identified (one patient underwent a second cranial reconstruction for identification of a separate, newly formed synostosis). Eighteen (30.5%) cases were associated with a neural tube defect (NTD). Patients with NTD and secondary craniosynostosis had on average earlier age of shunt placement (P = 0.001), craniosynostosis presentation (P = 0.146), and cranioplasty (P = 0.325) than secondary craniosynostosis patients without NTD.
Ventricular shunt drainage in treating hydrocephalus rarely may lead to early synostosis and cranial deformity, especially in patients with NTDs. Early shunt placement poses significant risk in patients with NTD. Close follow-up may be necessary to evaluate overdrainage and cranial deformity after shunting procedures.
颅骨缝早闭是先天性脑积水分流手术后一种罕见的并发症。我们报告一例出生时患有脊髓脊膜膨出且头型正常的儿童病例。她在3日龄时因Chiari畸形和脑积水接受了脑室分流术。术后即刻的CT扫描证实所有缝线均开放。系列CT扫描显示，2个月时额缝开放，5个月时额缝闭合，11个月时出现三角头畸形并伴有裂隙脑室综合征，以及侧脑室和第三脑室塌陷。
利用关键词“缝早闭与分流”在1948年至2017年期间进行了Ovid MEDLINE检索。记录所有患者及其各自的缝早闭模式。
我们在43年（1966 - 2017年）期间确定了8个病例系列和2例病例报告。共识别出78例患者有79种缝线缝早闭模式（1例患者接受了第二次颅骨重建以确定另一个新形成的独立缝早闭）。18例（30.5%）病例与神经管缺陷（NTD）相关。患有NTD和继发性颅骨缝早闭的患者相比没有NTD的继发性颅骨缝早闭患者，平均分流放置年龄更早（P = 0.001）、颅骨缝早闭表现更早（P = 0.146）以及颅骨成形术更早（P = 0.325）。
治疗脑积水时进行脑室分流引流很少会导致早期缝早闭和颅骨畸形，尤其是在患有NTD的患者中。早期分流放置对患有NTD的患者构成重大风险。分流术后可能需要密切随访以评估过度引流和颅骨畸形情况。
