Zubovic Ema, Skolnick Gary B, Naidoo Sybill D, Bellanger Mark, Smyth Matthew D, Patel Kamlesh B
1Division of Plastic & Reconstructive Surgery, Department of Surgery, and.
3Orthotic and Prosthetic Lab, St. Louis, Missouri.
J Neurosurg Pediatr. 2020 Apr 17;26(2):113-121. doi: 10.3171/2020.2.PEDS2029. Print 2020 Aug 1.
Combined metopic-sagittal craniosynostosis is traditionally treated with open cranial vault remodeling and fronto-orbital advancement, sometimes in multiple operations. Endoscopic treatment of this multisuture synostosis presents a complex challenge for the surgeon and orthotist.
The authors retrospectively analyzed the preoperative and 1-year postoperative CT scans of 3 patients with combined metopic-sagittal synostosis, all of whom were treated with simultaneous endoscope-assisted craniectomy of the metopic and sagittal sutures followed by helmet therapy. Established anthropometric measurements were applied to assess pre- and postoperative morphology, including cranial index and interfrontal divergence angle (IFDA). Patients' measurements were compared to those obtained in 18 normal controls.
Two boys and one girl underwent endoscope-assisted craniectomy at a mean age of 81 days. The mean preoperative cranial index was 0.70 (vs control mean of 0.82, p = 0.009), corrected postoperatively to a mean of 0.82 (vs control mean of 0.80, p = 0.606). The mean preoperative IFDA was 110.4° (vs control mean of 152.6°, p = 0.017), corrected postoperatively to a mean of 139.1° (vs control mean of 140.3°, p = 0.348). The mean blood loss was 100 mL and the mean length of stay was 1.7 days. No patient underwent reoperation. The mean clinical follow-up was 3.4 years.
Endoscope-assisted craniectomy with helmet therapy is a viable single-stage treatment option for combined metopic-sagittal synostosis, providing correction of the stigmata of trigonoscaphocephaly, with normalization of the cranial index and IFDA.
传统上，额缝-矢状缝联合颅缝早闭采用开放性颅穹窿重塑和额眶前移术治疗，有时需要进行多次手术。这种多缝性颅缝早闭的内镜治疗对外科医生和矫形师来说是一项复杂的挑战。
作者回顾性分析了3例额缝-矢状缝联合颅缝早闭患者的术前和术后1年CT扫描结果，所有患者均接受了同期内镜辅助额缝和矢状缝颅骨切除术，随后进行头盔治疗。采用既定的人体测量方法评估术前和术后的形态，包括颅指数和额间发散角（IFDA）。将患者的测量结果与18名正常对照者的测量结果进行比较。
2名男孩和1名女孩接受了内镜辅助颅骨切除术，平均年龄为81天。术前平均颅指数为0.70（对照组平均为0.82，p = 0.009），术后平均校正为0.82（对照组平均为0.80，p = 0.606）。术前平均IFDA为110.4°（对照组平均为152.6°，p = 0.017），术后平均校正为139.1°（对照组平均为140.3°，p = 0.348）。平均失血量为100 mL，平均住院时间为1.7天。没有患者接受再次手术。平均临床随访时间为3.4年。
内镜辅助颅骨切除术联合头盔治疗是额缝-矢状缝联合颅缝早闭的一种可行的单阶段治疗选择，可矫正三角头畸形的体征，使颅指数和IFDA正常化。
