Senda Daiki, Orgun Doruk, Shimizu Azusa, Shimoji Kazuaki, Miyajima Masakazu, Arai Hajime, Mizuno Hiroshi, Komuro Yuzo
Department of Plastic and Reconstructive Surgery.
Department of Neurosurgery, Juntendo University School of Medicine.
J Craniofac Surg. 2019 Jan;30(1):23-27. doi: 10.1097/SCS.0000000000004948.
Patients with craniosynostosis with shortened occipitofrontal diameter are mainly treated with posterior cranial vault distraction osteogenesis (PVDO) in our institution. If further intracranial volume (ICV) expansion is needed, additional treatment with frontal orbital advancement (FOA) is done. On the contrary, frontal orbital remodeling (FOR) is done for better aesthetic results. In this study, post-treatment ICV changes in patients with craniosynostosis treated with these methods have been investigated.
Patients who underwent FOA or FOR in addition to PVDO at Juntendo University Hospital between 2011 and 2017 were reviewed for patient characteristics and pre/postoperative ICV measurements using 3-dimensional computed tomography scans.
Nine patients aged from 5 months to 6 years 8 months at the time of PVDO were included. For PVDO, the ICV change was 113 to 328 mL, and the enlargement ratio of ICV was 109% to 152%. Two patients were further operated with FOA while the remaining 7 with FOR. With FOA, ICV change was 73 to 138 mL, while enlargement ratio of ICV was 107% to 114%. With FOR, ICV change was 3 to 45 mL (mean 20 mL), while enlargement ratio of ICV was 100% to 103%.
The PVDO is our first line of treatment for ICV expansion and posterior cranial fossa decompression in patients with severe craniosynostosis. The FOA is performed if extra ICV increase is necessary. This approach seems to enable larger ICV expansions compared with other conventional methods. The FOR should be reserved for patients in whom adequate ICV levels are achieved with PVDO yet additional frontal reshaping is necessary.
在我们机构中，枕额径缩短的颅缝早闭患者主要接受后颅穹窿牵张成骨术（PVDO）治疗。如果需要进一步扩大颅内体积（ICV），则进行额外的额眶前移术（FOA）治疗。相反，为了获得更好的美学效果，则进行额眶重塑术（FOR）。在本研究中，对采用这些方法治疗的颅缝早闭患者治疗后的ICV变化进行了研究。
回顾了2011年至2017年在顺天堂大学医院接受PVDO联合FOA或FOR治疗的患者的特征，并使用三维计算机断层扫描测量术前和术后的ICV。
纳入9例在PVDO时年龄为5个月至6岁8个月的患者。对于PVDO，ICV变化为113至328 mL，ICV扩大率为109%至152%。2例患者进一步接受FOA手术，其余7例接受FOR手术。采用FOA时，ICV变化为73至138 mL，ICV扩大率为107%至114%。采用FOR时，ICV变化为3至45 mL（平均20 mL），ICV扩大率为100%至103%。
PVDO是我们治疗严重颅缝早闭患者ICV扩大和后颅窝减压的一线治疗方法。如果需要额外增加ICV，则进行FOA。与其他传统方法相比，这种方法似乎能够实现更大的ICV扩大。FOR应保留给通过PVDO已达到足够ICV水平但仍需要额外额部重塑的患者。
