Szathmari A, Morgado A, Beuriat P A, Petrescu P, Di Rocco F, Mottolese C
Service de Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude-Bernard Lyon1, 59, boulevard Pinel, 69677 Bron, cedex, France.
Service de Neurochirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude-Bernard Lyon1, 59, boulevard Pinel, 69677 Bron, cedex, France.
Neurochirurgie. 2020 Apr;66(2):97-101. doi: 10.1016/j.neuchi.2019.10.015. Epub 2020 Feb 24.
Surgical treatment of craniosynostosis in children may generate secondary cranial vault defects by incomplete ossification process. The incidence of cranial defects after craniosynostosis surgery is poorly reported in the literature with a variable incidence of 0.5% to 18.2%. To better understand the impact and management of the cranial defects after craniosynostosis surgery, we selected and reviewed al cranioplasties that met this criterion between 2002 and 2019.
We found 41 patients (28 M and 13 F) operated between January 2002 to January 2019 who underwent cranioplasty for cranial defects secondary to craniosynostosis surgery in the infancy. All patient were at least 5 years old (range 5 to 17 years, median 11). The indication was aesthetic in 28 patients and for headaches, learning difficulties or changes in the cerebral blood flow in 13 patients. The material used in cranioplasty was the poly-methyl-methacrylate (PMMA) in 40 patients and customized porous hydroxyapatite (CPHA) in 1 patient.
The mean follow-up period after cranioplasty was of 37 months (range 2 to 125 months, median of 27 months). In the postoperative period there were no mortality nor neurological complications. There were 3 cases (7%) of superficial local postoperative wound infection but with no evidence of long-term infection. The long-term CT scan follow-up showed no material migration, dislocation or fractures.
Considering the characteristics of the cranial vault after craniosynostosis surgery the treatment by cranioplasty with heterologous materials appears to be feasible thus avoiding donor site morbidity. For selected cases with small defects, our experience shows that the use of PMMA may be a safe alternative for the cranial vault repair in children older than 5 years.
儿童颅缝早闭的手术治疗可能因骨化过程不完全而导致继发性颅骨穹窿缺损。文献中关于颅缝早闭手术后颅骨缺损的发生率报道较少，发生率在0.5%至18.2%之间不等。为了更好地了解颅缝早闭手术后颅骨缺损的影响及处理方法，我们选取并回顾了2002年至2019年间所有符合该标准的颅骨成形术病例。
我们发现有41例患者（男性28例，女性13例）在2002年1月至2019年1月期间接受了手术，这些患者因婴儿期颅缝早闭手术继发颅骨缺损而接受了颅骨成形术。所有患者年龄至少5岁（年龄范围5至17岁，中位数1岁）。28例患者的手术指征是出于美观考虑，13例患者是因头痛、学习困难或脑血流改变。颅骨成形术中使用的材料，40例患者使用了聚甲基丙烯酸甲酯（PMMA），1例患者使用了定制多孔羟基磷灰石（CPHA）。
颅骨成形术后的平均随访期为37个月（范围2至125个月，中位数27个月）。术后无死亡病例，也无神经并发症。有3例（7%）发生了浅表局部术后伤口感染，但无长期感染迹象。长期CT扫描随访显示没有材料移位、脱位或骨折。
考虑到颅缝早闭手术后颅骨穹窿的特点，采用异体材料进行颅骨成形术治疗似乎是可行的，从而避免了供区并发症。对于选定的小缺损病例，我们的经验表明，对于5岁以上儿童，使用PMMA可能是颅骨穹窿修复的一种安全选择。
