From the Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital; the Department of Neurologic Surgery, University of Virginia School of Medicine; and the Departments of Neurosurgery, Radiology, and Plastic and Oral Surgery, Boston Children's Hospital.
Plast Reconstr Surg. 2019 Jan;143(1):183-196. doi: 10.1097/PRS.0000000000005118.
Endoscopic suturectomy and helmeting represents a successful first-line surgical treatment for bilateral coronal craniosynostosis. Its effect on cranial morphology has not been previously described.
Patients were identified who had bilateral coronal craniosynostosis treated with endoscopic suturectomy and postoperative helmeting at Boston Children's Hospital between 2005 and 2013 and who underwent preoperative and postoperative computed tomography. Two normative patient populations were identified from our trauma registry with computed tomographic scans completed at the same age as our pretreatment and posttreatment scans. Craniometric indices were used to quantify the effect of treatment.
Twenty-seven patients were identified who underwent bilateral coronal suturectomy. Twelve patients had preoperative and postoperative computed tomographic studies. Eight patients (66.7 percent) were syndromic. The average ages for preoperative and postoperative computed tomographic scan were 1.1 months (range, 0.03 to 2.6 months) and 19.6 months (range, 10.8 to 37.5 months). Thirteen patients with an average age of 1.1 months (range, 0.5 to 1.6 months) were identified as a preoperative control group. Fourteen patients with an average age of 18.5 months (range, 15.5 to 22.9 months) were identified as a postoperative control group. The anterior cranial height stabilized with treatment and the anterior cranial base length increased. The anterior cranial height-to-anterior cranial base length ratio significantly decreased with treatment (p = 0.128). Frontal bossing normalized with endoscopic suturectomy (craniosynostosis versus control: preoperatively, p = 0.001; postoperatively, p = 0.8). Cephalic indices also normalized with treatment (craniosynostosis versus control: preoperatively, p = 0.02; postoperatively, p = 0.13). No cases of hydrocephalus were observed.
Endoscopic suturectomy and helmeting improves anterior turricephaly and corrects frontal bossing and brachycephaly in patients with bilateral coronal craniosynostosis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
内镜下缝合切除术和头盔治疗是双侧冠状缝早闭的有效一线手术治疗方法。但其对颅形的影响尚未被描述。
我们在波士顿儿童医院，于 2005 年至 2013 年期间，对 27 例双侧冠状缝早闭患者，行内镜下缝合切除术和术后头盔治疗，所有患者均行术前和术后 CT 检查。从我们的创伤登记处中，确定了 2 个具有相似年龄的正常患者群体，进行了与我们的术前和术后 CT 扫描相同的 CT 扫描。使用颅测指数来量化治疗效果。
27 例患者行双侧冠状缝切除术。12 例患者行术前和术后 CT 检查。8 例（66.7%）为综合征患者。术前和术后 CT 扫描的平均年龄分别为 1.1 个月（范围，0.03-2.6 个月）和 19.6 个月（范围，10.8-37.5 个月）。13 例平均年龄为 1.1 个月（范围，0.5-1.6 个月）的患者被确定为术前对照组。14 例平均年龄为 18.5 个月（范围，15.5-22.9 个月）的患者被确定为术后对照组。治疗后，前颅高度稳定，前颅底长度增加。治疗后，前颅高度与前颅底长度的比值明显降低（p=0.128）。内镜下缝合切除术使额骨隆起正常化（颅缝早闭与对照组：术前，p=0.001；术后，p=0.8）。头颅指数也随治疗而正常化（颅缝早闭与对照组：术前，p=0.02；术后，p=0.13）。未观察到脑积水病例。
内镜下缝合切除术和头盔治疗可改善双侧冠状缝早闭患者的前颅顶斜头畸形，并矫正额骨隆起和短头畸形。
临床问题/证据水平：治疗，IV。
