1French Referral Center for Craniosynostosis.
Departments of2Pediatric Neurosurgery and.
Neurosurg Focus. 2021 Apr;50(4):E4. doi: 10.3171/2021.1.FOCUS201004.
Different types of surgical procedures are utilized to treat craniosynostosis. In most procedures, the fused suture is removed. There are only a few reports on the evolution of sutures after surgical correction of craniosynostosis. To date, no published study describes neosuture formation after total cranial vault remodeling. The objective of this study was to understand the evolution of the cranial bones in the area of coronal and lambdoid sutures that were removed for complete vault remodeling in patients with sagittal craniosynostosis. In particular, the investigation aimed to confirm the possibility of neosuture formation.
CT images of the skulls of children who underwent operations for scaphocephaly at the Hôpital Femme Mère Enfant, Lyon University Hospital, Lyon, France, from 2004 to 2014 were retrospectively reviewed. Inclusion criteria were diagnosis of isolated sagittal synostosis, age between 4 and 18 months at surgery, and availability of reliable postoperative CT images obtained at a minimum of 1 year after surgical correction. Twenty-six boys and 11 girls were included, with a mean age at surgery of 231.6 days (range 126-449 days). The mean interval between total vault reconstruction and CT scanning was 5.3 years (range 1.1-12.2 years).
Despite the removal of both the coronal and lambdoid sutures, neosutures were detected on the 3D reconstructions. All combinations of neosuture formation were seen: visible lambdoid and coronal neosutures (n = 20); visible lambdoid neosutures with frontoparietal bony fusion (n = 12); frontoparietal and parietooccipital bony fusion (n = 3); and visible coronal neosutures with parietooccipital bony fusion (n = 2).
This is the first study to report the postoperative skull response after the removal of normal patent sutures following total vault remodeling in patients with isolated sagittal synostosis. The reappearance of a neosuture is rather common, but its incidence depends on the type of suture. The outcome of the suture differs with the incidence of neosuture formation between these transverse sutures. This might imply genetic and functional differences among cranial sutures, which still have to be elucidated.
不同类型的手术用于治疗颅缝早闭。在大多数手术中，融合的骨缝被切除。关于颅缝早闭手术后骨缝的演变仅有少数报道。迄今为止，没有发表的研究描述完全颅盖重塑后新骨缝的形成。本研究的目的是了解冠状缝和人字缝骨在矢状颅缝早闭患者接受完全颅盖重塑时被切除后的演变。特别是，研究旨在确认新骨缝形成的可能性。
回顾性分析 2004 年至 2014 年法国里昂大学医院 Femme Mère Enfant 医院接受舟状头畸形手术的儿童头颅 CT 图像。纳入标准为孤立性矢状缝早闭的诊断、手术时年龄在 4 至 18 个月之间、以及术后至少 1 年获得可靠的 CT 图像。共纳入 26 名男孩和 11 名女孩，手术时的平均年龄为 231.6 天（范围 126-449 天）。总颅盖重建与 CT 扫描之间的平均间隔为 5.3 年（范围 1.1-12.2 年）。
尽管冠状缝和人字缝均被切除，但在 3D 重建中仍发现了新骨缝。可见的新骨缝形成的组合均可见：可见的人字缝和冠状缝新骨缝（n = 20）；可见人字缝和额顶骨融合（n = 12）；额顶骨和顶枕骨融合（n = 3）；可见冠状缝和顶枕骨融合（n = 2）。
这是第一项报道在孤立性矢状缝早闭患者接受完全颅盖重塑后切除正常开放骨缝后术后颅骨反应的研究。新骨缝的再现相当常见，但发生率取决于骨缝的类型。不同类型的颅缝在新骨缝形成的发生率上存在差异，这可能意味着颅缝之间存在遗传和功能差异，这些差异仍有待阐明。
