Philadelphia, Pa.; and Winston-Salem, N.C.
From the Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and the Division of Plastic and Reconstructive Surgery, Wake Forest University.
Plast Reconstr Surg. 2018 Apr;141(4):559e-570e. doi: 10.1097/PRS.0000000000004238.
Cranial base sutures are important drivers of both facial and cranial growth. The purpose of this study was to compare the incidence and location of cranial base suture fusion among three groups: nonaffected controls, patients with nonsyndromic craniosynostosis, and patients with syndromic craniosynostosis.
Patients and computed tomographic scans were accrued from the authors' prospective craniofacial database. Computed tomographic scans were graded on the frequency of cranial vault and cranial base suture/synchondrosis fusion (0, open; 1, partially/completely fused) by an attending craniofacial surgeon and neuroradiologist. Statistical comparisons were conducted on location and rates of fusion, age, and diagnosis.
One hundred forty patients met inclusion criteria: 55 syndromic, 64 nonsyndromic, and 21 controls. Average age at computed tomography of syndromic patients (3.6 ± 3.1 months) was younger than that of nonsyndromic patients (5.4 ± 3.1 months; p = 0.001) and control subjects (5.1 ± 3.2 months; p = 0.058). Syndromic craniosynostotic patients had over three times as many cranial base minor sutures fused (2.2 ± 2.5) as nonsyndromic craniosynostosis patients (0.7 ± 1.2; p < 0.001) and controls (0.4 ± 0.8; p = 0.002), whose rates of fusion were statistically equivalent (p = 0.342). Syndromic craniosynostosis patients had a greater frequency of cranial base suture fusion in the coronal branches, squamosal arch, and posterior intraoccipital synchondrosis (p < 0.05).
Patients with syndromic craniosynostosis have higher rates of cranial base suture fusion in infancy, especially in the coronal arches, and this may have significant implications for both cranial and facial growth. In contrast, patients with nonsyndromic craniosynostosis have similar rates and sites of cranial base suture fusion as controls. Interestingly, there is a low, "normal," rate of cranial base suture/synchondrosis closure in infancy, the implications of which are unknown.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
颅底缝是面部和颅面生长的重要驱动因素。本研究的目的是比较三组患者（非综合征型颅缝早闭患者、综合征型颅缝早闭患者和非综合征型对照组）颅底缝融合的发生率和位置。
本研究从作者前瞻性颅面数据库中招募了患者和 CT 扫描。由一名主治颅面外科医生和神经放射科医生对 CT 扫描进行颅盖和颅底缝/软骨结合融合频率的分级（0 级：开放；1 级：部分/完全融合）。对融合的位置和融合率、年龄和诊断进行了统计学比较。
共有 140 名患者符合纳入标准：55 名综合征型患者、64 名非综合征型患者和 21 名对照组。综合征型患者 CT 检查的平均年龄（3.6±3.1 个月）小于非综合征型患者（5.4±3.1 个月；p=0.001）和对照组（5.1±3.2 个月；p=0.058）。综合征型颅缝早闭患者颅底较小的缝融合率（2.2±2.5）是颅缝早闭患者（0.7±1.2；p<0.001）和对照组（0.4±0.8；p=0.002）的三倍多，而且两组的融合率相当（p=0.342）。综合征型颅缝早闭患者冠状支、鳞状弓和后枕骨间软骨融合率更高（p<0.05）。
综合征型颅缝早闭患者在婴儿期颅底缝融合率更高，尤其是冠状支，这可能对颅面和面部生长都有重要影响。相反，非综合征型颅缝早闭患者颅底缝融合率和位置与对照组相似。有趣的是，婴儿期颅底缝/软骨结合有较低的“正常”融合率，其意义尚不清楚。
临床问题/证据水平：风险，III 级。
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