Divisions of1Pediatric Neurosurgery, Primary Children's Hospital, and.
2Division of Neurosurgery, University of California, San Diego, California.
Neurosurg Focus. 2021 Apr;50(4):E3. doi: 10.3171/2021.1.FOCUS201029.
Sagittal synostosis is the most common form of isolated craniosynostosis. Although some centers have reported extensive experience with this condition, most reports have focused on a single center. In 2017, the Synostosis Research Group (SynRG), a multicenter collaborative network, was formed to study craniosynostosis. Here, the authors report their early experience with treating sagittal synostosis in the network. The goals were to describe practice patterns, identify variations, and generate hypotheses for future research.
All patients with a clinical diagnosis of isolated sagittal synostosis who presented to a SynRG center between March 1, 2017, and October 31, 2019, were included. Follow-up information through October 31, 2020, was included. Data extracted from the prospectively maintained SynRG registry included baseline parameters, surgical adjuncts and techniques, complications prior to discharge, and indications for reoperation. Data analysis was descriptive, using frequencies for categorical variables and means and medians for continuous variables.
Two hundred five patients had treatment for sagittal synostosis at 5 different sites. One hundred twenty-six patients were treated with strip craniectomy and 79 patients with total cranial vault remodeling. The most common strip craniectomy was wide craniectomy with parietal wedge osteotomies (44%), and the most common cranial vault remodeling procedure was total vault remodeling without forehead remodeling (63%). Preoperative mean cephalic indices (CIs) were similar between treatment groups: 0.69 for strip craniectomy and 0.68 for cranial vault remodeling. Thirteen percent of patients had other health problems. In the cranial vault cohort, 81% of patients who received tranexamic acid required a transfusion compared with 94% of patients who did not receive tranexamic acid. The rates of complication were low in all treatment groups. Five patients (2%) had an unintended reoperation. The mean change in CI was 0.09 for strip craniectomy and 0.06 for cranial vault remodeling; wide craniectomy resulted in a greater change in CI in the strip craniectomy group.
The baseline severity of scaphocephaly was similar across procedures and sites. Treatment methods varied, but cranial vault remodeling and strip craniectomy both resulted in satisfactory postoperative CIs. Use of tranexamic acid may reduce the need for transfusion in cranial vault cases. The wide craniectomy technique for strip craniectomy seemed to be associated with change in CI. Both findings seem amenable to testing in a randomized controlled trial.
矢状缝早闭是最常见的颅缝早闭类型。尽管一些中心有广泛的经验报告，但大多数报告都集中在单一中心。2017 年，颅缝早闭研究组（SynRG）成立，这是一个多中心合作网络，旨在研究颅缝早闭。在此，作者报告了他们在该网络中治疗矢状缝早闭的早期经验。目标是描述实践模式、确定差异并为未来的研究提出假设。
所有在 2017 年 3 月 1 日至 2019 年 10 月 31 日期间在 SynRG 中心就诊的临床诊断为孤立性矢状缝早闭的患者均被纳入研究。随访信息截至 2020 年 10 月 31 日。从前瞻性维护的 SynRG 注册中心提取的数据包括基线参数、手术辅助和技术、出院前并发症以及再次手术的指征。数据分析采用描述性方法，使用分类变量的频率和连续变量的平均值和中位数。
在 5 个不同的地点，有 205 例患者接受了矢状缝早闭治疗。126 例患者接受了颅骨切开术，79 例患者接受了全颅穹窿重建术。最常见的颅骨切开术是广泛颅骨切开术伴顶骨楔形截骨术（44%），最常见的颅穹窿重建术是全颅穹窿重建而不进行额部重建（63%）。术前平均头围指数（CI）在治疗组之间相似：颅骨切开术组为 0.69，颅穹窿重建术组为 0.68。13%的患者有其他健康问题。在颅穹窿组中，81%接受氨甲环酸治疗的患者需要输血，而未接受氨甲环酸治疗的患者为 94%。所有治疗组的并发症发生率均较低。5 例（2%）患者出现非预期的再次手术。颅骨切开术组的 CI 平均变化为 0.09，颅穹窿重建术组的 CI 平均变化为 0.06；广泛颅骨切开术导致颅骨切开术组的 CI 变化更大。
手术严重程度在不同手术组和手术部位之间相似。治疗方法存在差异，但颅穹窿重建术和颅骨切开术都能获得满意的术后 CI。在颅穹窿病例中使用氨甲环酸可能减少输血的需求。颅骨切开术的广泛颅骨切开术技术似乎与 CI 的变化有关。这两种发现似乎都适合在随机对照试验中进行测试。
