Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Université de Lyon, 59 bd Pinel, 69003, Lyon, France.
, Centre de Référence Craniosténoses, Lyon, France.
Childs Nerv Syst. 2021 Apr;37(4):1159-1165. doi: 10.1007/s00381-020-04982-z. Epub 2021 Jan 6.
The premature fusion of the metopic suture may be associated with the presence of emissary veins (EV) and abnormally large pericerebral cerebrospinal fluid (CSF) spaces which suggest an associated focal disturbance in CSF dynamics. The incidence of such findings and their potential significance in terms of management of the disease have not been fully elucidated. The aim of this study is to investigate whether these phenomena identify specific subtypes of trigonocephaly. In such a direction, we evaluated the volume of the pericerebral CSF spaces and their relationship to the morphology ("Ω," "V," or flat type) of the prematurely fused metopic suture and to the value of the interfrontal angle value on the grounds of computed tomographic (CT) scan examinations.
The preoperative brain CT scans of 74 children (52 boys, 22 girls) with trigonocephaly who had undergone fronto-orbital remodeling were evaluated. The volume of the pericerebral CSF spaces and the value of the interfrontal angle were calculated. The type of intracranial notch was studied and classified according to its shape on the preoperative CT scan: a groove "Ω," a ridge/"V" ridge or absent when flat and evidence of emissary veins related to the abnormally fused suture.
Preoperatively, an endocranial metopic groove or ridge was seen in 70% of the children. Emissary veins were identified in 34 of 74 patients (45%), at a mean distance of 2.04 cm (1.18-2.94 cm) from the nasion. The presence of large pericerebral CSF spaces significantly correlated with the presence of EV (p < 0.05), with the "Ω" type (p < 0.05) and with interfrontal angles under 134° (p < 0.005).
Metopic suture early fusion shows an association between EV, pericerebral CSF spaces, and the "Ω" groove appearance of the suture. This association identifies a specific subgroup in which the presence of emissary veins and large pericerebral CSF spaces is an indicator of local venous hypertension due to the sagittal sinus constriction within an osseous groove created by the abnormal suture fusion process. The implications for the surgical management and long-term results as compared to trigonocephalic children with small or absent normal peripheral spaces and EV are still to be determined.
额缝过早融合可能与导血管（EV）的存在和异常大的颅周脑脊液（CSF）空间有关，这表明 CSF 动力学存在相关的局灶性障碍。这些发现的发生率及其在疾病管理方面的潜在意义尚未完全阐明。本研究旨在探讨这些现象是否能确定三角头畸形的特定亚型。为此，我们评估了颅周 CSF 空间的体积及其与过早融合的额缝形态（“Ω”、“V”或扁平型）和额间角值的关系，额间角值是基于 CT 扫描检查得出的。
对 74 例接受额眶成形术的三角头畸形患儿的术前脑 CT 扫描进行评估。计算颅周 CSF 空间的体积和额间角的值。研究颅内切迹的类型，并根据术前 CT 扫描的形状进行分类：凹槽“Ω”、脊/“V”脊或扁平时不存在以及与异常融合缝相关的导血管的证据。
术前，70%的患儿可见额缝内陷或隆起。74 例患儿中有 34 例（45%）存在导血管，平均距离鼻根 2.04cm（1.18-2.94cm）。大的颅周 CSF 空间的存在与 EV 的存在显著相关（p<0.05），与“Ω”型（p<0.05）和额间角小于 134°（p<0.005）相关。
额缝早期融合与 EV、颅周 CSF 空间和缝的“Ω”槽形外观之间存在关联。这种关联确定了一个特定的亚组，其中导血管和大的颅周 CSF 空间的存在是由于矢状窦在异常缝融合过程中在骨槽内收缩导致局部静脉高压的指标。与额缝正常小或不存在且 EV 的三角头患儿相比，其对手术管理和长期结果的影响仍有待确定。
