Dalle Ore Cecilia L, Dilip Monisha, Brandel Michael G, McIntyre Joyce K, Hoshide Reid, Calayag Mark, Gosman Amanda A, Cohen Steven R, Meltzer Hal S
1Department of Neurosurgery, University of California San Diego; and.
Divisions of2Plastic Surgery and.
J Neurosurg Pediatr. 2018 Oct;22(4):335-343. doi: 10.3171/2018.2.PEDS17364. Epub 2018 Jul 6.
In this paper the authors review their 16-year single-institution consecutive patient experience in the endoscopic treatment of nonsyndromic craniosynostosis with an emphasis on careful review of any associated treatment-related complications and methods of complication avoidance, including preoperative planning, intraoperative management, and postoperative care and follow-up.
A retrospective chart review was conducted on all patients undergoing endoscopic, minimally invasive surgery for nonsyndromic craniosynostosis at Rady Children's Hospital from 2000 to 2015. All patients were operated on by a single neurosurgeon in collaboration with two plastic and reconstructive surgeons as part of the institution's craniofacial team.
Two hundred thirty-five patients underwent minimally invasive endoscopic surgery for nonsyndromic craniosynostosis from 2000 to 2015. The median age at surgery was 3.8 months. The median operative and anesthesia times were 55 and 105 minutes, respectively. The median estimated blood loss (EBL) was 25 ml (median percentage EBL 4.2%). There were no identified episodes of air embolism or operative deaths. One patient suffered an intraoperative sagittal sinus injury, 2 patients underwent intraoperative conversion of planned endoscopic to open procedures, 1 patient experienced a dural tear, and 1 patient had an immediate reexploration for a developing subgaleal hematoma. Two hundred twenty-five patients (96%) were admitted directly to the standard surgical ward where the median length of stay was 1 day. Eight patients were admitted to the intensive care unit (ICU) postoperatively, 7 of whom had preexisting medical conditions that the team had identified preoperatively as necessitating a planned ICU admission. The 30-day readmission rate was 1.7% (4 patients), only 1 of whom had a diagnosis (surgical site infection) related to their initial admission. Average length of follow-up was 2.8 years (range < 1 year to 13.4 years). Six children (< 3%) had subsequent open procedures for perceived suboptimal aesthetic results, 4 of whom (> 66%) had either coronal or metopic craniosynostosis. No patient in this series either presented with or subsequently developed signs or symptoms of intracranial hypertension.
In this large single-center consecutive patient series in the endoscopic treatment of nonsyndromic craniosynostosis, significant complications were avoided, allowing for postoperative care for the vast majority of infants on a standard surgical ward. No deaths, catastrophic postoperative morbidity, or evidence of the development of symptomatic intracranial hypertension was observed.
在本文中，作者回顾了他们在一家机构连续16年对非综合征性颅缝早闭症进行内镜治疗的患者经验，重点仔细审查了任何与治疗相关的并发症以及避免并发症的方法，包括术前规划、术中管理、术后护理和随访。
对2000年至2015年在瑞迪儿童医院接受非综合征性颅缝早闭症内镜微创手术的所有患者进行回顾性病历审查。所有患者均由一名神经外科医生与两名整形和重建外科医生合作进行手术，作为该机构颅面团队的一部分。
2000年至2015年，235例患者接受了非综合征性颅缝早闭症的微创内镜手术。手术时的中位年龄为3.8个月。中位手术时间和麻醉时间分别为55分钟和105分钟。中位估计失血量（EBL）为25毫升（EBL中位百分比为4.2%）。未发现空气栓塞或手术死亡事件。1例患者术中矢状窦损伤，2例患者术中将计划的内镜手术转为开放手术，1例患者硬膜撕裂，1例患者因帽状腱膜下血肿形成立即再次手术探查。225例患者（96%）直接入住标准外科病房，中位住院时间为1天。8例患者术后入住重症监护病房（ICU），其中7例术前存在医疗状况，团队术前已确定需要计划入住ICU。30天再入院率为1.7%（4例患者），其中只有1例的诊断（手术部位感染）与初次入院有关。平均随访时间为2.8年（范围<1年至13.4年）。6名儿童（<(3%)）因美学效果欠佳随后接受了开放手术，其中4名（>66%）患有冠状缝或额缝颅缝早闭症。本系列中没有患者出现或随后出现颅内高压的体征或症状。
在这个大型单中心连续患者系列中，对非综合征性颅缝早闭症进行内镜治疗时，避免了严重并发症，使得绝大多数婴儿可在标准外科病房接受术后护理。未观察到死亡、灾难性术后发病率或有症状颅内高压发展的证据。
