Hughes Christopher D, Langa Olivia, Nuzzi Laura, Staffa Steven J, Proctor Mark, Meara John G, Ganske Ingrid M
Division of Plastic and Craniofacial Surgery, Connecticut Children's, Hartford, Conn.
Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Mass.
Plast Reconstr Surg Glob Open. 2021 May 21;9(5):e3493. doi: 10.1097/GOX.0000000000003493. eCollection 2021 May.
Surgical correction of craniosynostosis addresses potentially elevated intracranial pressure and the cranial deformity. In nonsyndromic sagittal synostosis, approximately 15% of patients have elevated intracranial pressure. The decision to operate therefore likely reflects a combination of aesthetic goals, prevention of brain growth restriction over time, surgeon training and experience, and parental expectations. This study examines clinical factors that influence surgical decision-making in nonsyndromic sagittal synostosis.
An online survey sent to craniofacial and neurosurgeons presented 5 theoretical patients with varying severities of sagittal synostosis. For each cephalic index, 4 separate clinical scenarios were presented to assess influences of parental concern and developmental delay on the decision to operate.
Fifty-six surveys were completed (response rate = 28%). Participants were predominantly from North America (57%), had over 10 years of experience (75%), and performed over 20 craniosynostosis procedures annually (50%). Thirty percent of respondents indicated they would operate regardless of head shape and without clinical and/or parental concern. Head shape was the greatest predictor of decision to operate ( < 0.001). Parental concern and developmental delay were independently associated with decision to operate ( < 0.001). Surgeons with more experience were also more likely to operate across all phenotypes (OR: 2.69, < 0.004).
Surgeons responding to this survey were more strongly compelled to operate on children with nonsyndromic sagittal craniosynostosis when head shape was more severe. Additional factors, including parental concern and developmental delay, also influence the decision to operate, especially for moderate phenotypes. Geographic and subspecialty variations were not significant.
颅骨缝早闭的手术矫正可解决潜在升高的颅内压和颅骨畸形问题。在非综合征性矢状缝早闭中，约15%的患者颅内压升高。因此，手术决策可能反映了美学目标、预防随时间推移脑生长受限、外科医生的培训和经验以及家长期望等多种因素的综合作用。本研究探讨影响非综合征性矢状缝早闭手术决策的临床因素。
向颅面外科医生和神经外科医生发送的一项在线调查展示了5例矢状缝早闭严重程度不同的理论患者。对于每个头指数，呈现4种不同的临床场景，以评估家长关注和发育迟缓对手术决策的影响。
共完成56份调查问卷（回复率 = 28%）。参与者主要来自北美（57%），有超过10年的经验（75%），且每年进行超过20例颅骨缝早闭手术（50%）。30%的受访者表示，无论头部形状如何，且在无临床和/或家长关注的情况下，他们都会选择手术。头部形状是手术决策的最大预测因素（<0.001）。家长关注和发育迟缓与手术决策独立相关（<0.001）。经验更丰富的外科医生在所有表型中也更倾向于进行手术（比值比：2.69，<0.004）。
参与本次调查的外科医生在面对头部形状更严重的非综合征性矢状缝早闭患儿时，更倾向于进行手术。其他因素，包括家长关注和发育迟缓，也会影响手术决策，尤其是对于中度表型。地域和亚专业差异不显著。
