From the Division of Plastic Surgery, Department of Surgery, and the Department of Neurosurgery, University of Michigan.
Plast Reconstr Surg. 2021 May 1;147(5):1133-1139. doi: 10.1097/PRS.0000000000007830.
Clinical findings in children with unilateral coronal craniosynostosis are characteristic, and therefore clinicians have questioned the need for confirmatory imaging. Preoperative computed tomographic imaging is a powerful tool for diagnosing associated anomalies that can alter treatment management and surgical planning. The authors' aim was to determine whether and how routine preoperative imaging affected treatment management in unilateral coronal craniosynostosis patients within their institution.
A retrospective, single-center review of all patients who underwent cranial vault remodeling for unilateral coronal craniosynostosis between 2006 and 2014 was performed. Patient data included demographics, age at computed tomographic scan, age at surgery, results of the radiographic evaluation, and modification of treatment following radiologic examination.
Of 194 patients diagnosed with single-suture craniosynostosis, 29 were diagnosed with unilateral coronal craniosynostosis. Additional radiographic anomalies were found in 19 unilateral coronal craniosynostosis patients (65.5 percent). These included severe deviation of the anterior superior sagittal sinus [n = 12 (41.4 percent)], Chiari I malformation [n = 1 (3.4 percent)], and benign external hydrocephalus [n = 2 (6.9 percent)]. The radiographic anomalies resulted in a change in management for 48.3 percent of patients. Specifically, alteration in frontal craniotomy design occurred in 12 patients (41.4 percent), and two patients (6.9 percent) required further radiographic studies.
Although clinical findings in children with unilateral coronal craniosynostosis are prototypical, preoperative computed tomographic imaging is still of great consequence and continues to play an important role in surgical management. Preoperative imaging enabled surgeons to alter surgical management and avoid inadvertent complications such as damage to a deviated superior sagittal sinus. Imaging findings of Chiari malformation and hydrocephalus also permitted judicious follow-up.
CLINICAL QUESTIONS/LEVEL OF EVIDENCE: Therapeutic, IV.
单侧冠状缝颅缝早闭患儿的临床表现具有特征性，因此临床医生质疑是否需要进行影像学确认。术前计算机断层扫描成像（computed tomography，CT）是诊断相关畸形的有力工具，这些畸形可能改变治疗管理和手术计划。作者旨在确定他们机构内单侧冠状缝颅缝早闭患者的常规术前影像学检查是否以及如何影响治疗管理。
对 2006 年至 2014 年间接受颅骨穹窿重塑术治疗的单侧冠状缝颅缝早闭患者进行回顾性单中心研究。患者数据包括人口统计学资料、CT 扫描年龄、手术年龄、影像学评估结果以及影像学检查后治疗方案的改变。
在 194 例被诊断为单一缝颅缝早闭的患者中，有 29 例被诊断为单侧冠状缝颅缝早闭。19 例单侧冠状缝颅缝早闭患者中发现了其他放射影像学异常（65.5%）。这些异常包括严重的前上矢状窦偏斜[12 例（41.4%）]、Chiari I 畸形[1 例（3.4%）]和良性外部脑积水[2 例（6.9%）]。放射影像学异常导致 48.3%的患者治疗方案发生改变。具体而言，12 例患者（41.4%）改变了额部开颅设计，2 例患者（6.9%）需要进一步的影像学研究。
尽管单侧冠状缝颅缝早闭患儿的临床表现具有典型性，但术前 CT 成像仍然非常重要，并继续在手术管理中发挥重要作用。术前影像学检查使外科医生能够改变手术管理，并避免因矢状窦偏斜而导致的意外并发症。Chiari 畸形和脑积水的影像学发现也允许进行明智的随访。
临床问题/证据水平：治疗性，IV。
