Moderie Christophe, Govshievich Alexander, Papay Frank, Fearon Jeffrey, Gosain Arun, Doumit Gaby
Faculty of Medicine, University of Montreal, Montreal, Quebec.
Department of Plastic Surgery, University of Montreal, Montreal, Quebec.
Plast Reconstr Surg Glob Open. 2019 May 16;7(5):e2229. doi: 10.1097/GOX.0000000000002229. eCollection 2019 May.
Although the natural history of nonsyndromic unilateral coronal craniosynostosis has been extensively described, optimal management remains controversial due to lack of Level 1 evidence. This study aims to assess the current state of practice among craniofacial surgeons.
Ninety-four craniofacial surgeons were approached to complete a survey consisting of 15 questions. Data were collected assessing surgeons' primary surgical indication, timing of intervention, preoperative imaging, and choice of technique for patients presenting with nonsyndromic unilateral coronal craniosynostosis. Choice of technique and timing of intervention in case of recurrence were also investigated.
After 5 mailings, the response rate was 61%. The combination of both appearance and raised intracranial pressure was the primary indication for treatment for 73.2% of surgeons. Preoperative CT scan of the skull was "always" performed by 70.1% of respondents. Open surgical management was most commonly performed at 8-10 months of age (38.6%). Bilateral frontal craniectomy with remodeling of the supraorbital bandeau and frontal bone was the most common choice of procedure (84.2%). In case of mild to moderate and moderate to severe recurrences at 1 year of age, 89.5% and 47.4% of surgeons opted for conservative management, respectively. Optimal timing for repeat cranioplasty was after 4 years of age (65.5%). Overall, 43.4% quoted lack of evidence as the greatest obstacle to clinical decision-making when dealing with unilateral synostosis.
This survey exposes the lack of consensus and the disparity of opinion among craniofacial surgeons regarding the management of nonsyndromic coronal synostosis, particularly in the setting of recurrence.
尽管非综合征性单侧冠状缝早闭的自然病史已被广泛描述，但由于缺乏一级证据，最佳治疗方案仍存在争议。本研究旨在评估颅面外科医生的当前实践状况。
邀请94名颅面外科医生完成一项包含15个问题的调查。收集的数据评估了外科医生对于非综合征性单侧冠状缝早闭患者的主要手术指征、干预时机、术前影像学检查以及技术选择。还调查了复发情况下的技术选择和干预时机。
经过5次邮寄，回复率为61%。外观和颅内压升高同时存在是73.2%的外科医生的主要治疗指征。70.1%的受访者“总是”进行术前头颅CT扫描。开放性手术治疗最常在8至10个月大时进行（38.6%）。双侧额骨切除术联合眶上带和额骨重塑是最常见的手术选择（84.2%）。在1岁时出现轻度至中度和中度至重度复发的情况下，分别有89.5%和47.4%的外科医生选择保守治疗。重复颅骨成形术的最佳时机是4岁以后（65.5%）。总体而言，43.4%的人认为缺乏证据是处理单侧缝早闭时临床决策的最大障碍。
这项调查揭示了颅面外科医生在非综合征性冠状缝早闭治疗方面缺乏共识和意见差异，特别是在复发情况下。
