1Department of Neurosurgery, Karolinska University Hospital, Stockholm.
2Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and.
Neurosurg Focus. 2021 Apr;50(4):E7. doi: 10.3171/2021.1.FOCUS201017.
Isolated nonsyndromic sagittal synostosis (SS) is the most common form of craniosynostosis in children, accounting for approximately 60% of all craniosynostoses. The typical cranial measurement used to define and follow SS is the cephalic index (CI). Several surgical techniques have been suggested, but agreement on type and timing of surgery is lacking. This study aimed to evaluate the authors' institutional experience of surgically treating SS using a modified subtotal cranial vault remodeling technique in a population-based cohort. Special attention was directed toward the effect of patient age at time of surgery on long-term CI outcome.
A retrospective analysis was conducted on all patients with isolated nonsyndromic SS who were surgically treated from 2003 to 2011. Data from electronic medical records were gathered. Eighty-two patients with SS were identified, 77 fulfilled inclusion criteria, and 72 had sufficient follow-up data and were included. CI during follow-up after surgery was investigated with ANOVA and a linear mixed model.
In total, 72 patients were analyzed, consisting of 16 females (22%) and 56 males (78%). The mean ± SD age at surgery was 4.1 ± 3.1 months. Blood transfusions were received by 81% of patients (26% intraoperatively, 64% postoperatively, 9% both). The mean ± SD time in the pediatric ICU was 1.1 ± 0.25 days, and the mean ± SD total hospital length of stay was 4.6 ± 2.0 days. No patient required reoperation. The mean ± SD CI increased from 69 ± 3 to 87 ± 5 for patients who underwent surgery before 45 days of age. Surgery resulted in a larger increase in CI for patients who underwent surgery at a younger age compared with older patients (p < 0.05, Tukey's HSD test). In the comparison of patients who underwent surgery before 45 days of age with patients who underwent surgery at 45-90, 90-180, and more than 180 days of age, the linear mixed model estimated a long-term loss of CI of 3.0, 5.5, and 7.4 points, respectively.
The modified subtotal cranial vault remodeling technique used in this study significantly improved CI in patients with SS. The best results were achieved when surgery was performed early in life.
孤立性矢状缝早闭（SS）是儿童中最常见的颅缝早闭类型，约占所有颅缝早闭的 60%。用于定义和随访 SS 的典型头颅测量值是头围指数（CI）。已经提出了几种手术技术，但对于手术类型和时间的共识仍存在欠缺。本研究旨在评估作者机构在基于人群的队列中使用改良的部分颅盖重塑技术治疗 SS 的经验。特别关注手术时患者年龄对长期 CI 结果的影响。
对 2003 年至 2011 年期间接受手术治疗的所有孤立性非综合征性 SS 患者进行了回顾性分析。收集电子病历数据。共确定 82 例 SS 患者，其中 77 例符合纳入标准，72 例有足够的随访数据且纳入分析。采用方差分析和线性混合模型研究术后随访期间的 CI。
共分析 72 例患者，包括 16 例女性（22%）和 56 例男性（78%）。手术时的平均年龄为 4.1 ± 3.1 个月。81%的患者接受了输血（术中 26%，术后 64%，两者均有 9%）。儿科重症监护病房的平均时间为 1.1 ± 0.25 天，总住院时间的平均为 4.6 ± 2.0 天。无患者需要再次手术。手术前 45 天内接受手术的患者的平均 CI 从 69 ± 3 增加到 87 ± 5，而手术年龄较小的患者 CI 增加幅度大于年龄较大的患者（p < 0.05，Tukey 的 HSD 检验）。在比较手术前 45 天内的患者与手术前 45-90 天、90-180 天和超过 180 天的患者时，线性混合模型估计长期 CI 损失分别为 3.0、5.5 和 7.4 分。
本研究中使用的改良部分颅盖重塑技术显著改善了 SS 患者的 CI。在生命早期进行手术时，可获得最佳结果。
