University of Florida, Lillian S. Wells Department of Neurosurgery.
University of Florida College of Medicine; and.
J Craniofac Surg. 2022;33(5):1454-1457. doi: 10.1097/SCS.0000000000008357. Epub 2021 Nov 2.
Craniosynostosis is the premature fusion of 1 or more cranial sutures. The presentation may vary, and there are differing opinions regarding surgical indications and timing. Though increased intracranial pressure (ICP) is a well-established risk of craniosynostosis, its response to treatment is not uniform. This study aims to identify the signs and symptoms indicative of increased ICP that are most likely to improve after craniosynostosis surgery.
Pre- and post-operative data were retrospectively collected from patients at our institution with syndromic and non-syndromic craniosynostosis from January 2009 to June 2020. Demographics, symptoms (headache, nausea, emesis, and lethargy), signs (visual disturbances and papilledema), and imaging characteristics (copper beaten changes), if available, were analyzed.
One hundred fifty-three children with craniosynostosis were identified, and 56 with preoperative symptoms met inclusion criteria. Older age was significantly correlated with the number of symptoms improved postoperatively ( P = 0.015). Papilledema, headache, nausea, and irritability (if present preoperatively) were the features most likely to improve after craniosynostosis repair. Optic nerve or disc anomalies, feeding difficulties, seizures, and need for glasses were least likely to improve.
Older children undergoing craniosynostosis surgery had a greater number of improved symptoms. Classical features of increased ICP were more likely to improve than developmental difficulties and multifactorial causes. These findings may be useful when considering craniosynostosis repair in a symptomatic child.
颅缝早闭是指 1 条或多条颅骨缝过早融合。临床表现多样，对于手术适应证和时机存在不同意见。虽然颅内压升高（ICP）是颅缝早闭的一个明确风险，但对其治疗的反应并不一致。本研究旨在确定最有可能在颅缝早闭手术后改善的提示 ICP 升高的体征和症状。
从 2009 年 1 月至 2020 年 6 月，我们回顾性地收集了来自本机构患有综合征型和非综合征型颅缝早闭的患者的术前和术后数据。分析了人口统计学资料、症状（头痛、恶心、呕吐和嗜睡）、体征（视觉障碍和视盘水肿）和影像学特征（铜皮样改变），如果有则进行分析。
共确定了 153 例颅缝早闭患儿，其中 56 例术前有症状符合纳入标准。年龄较大与术后改善的症状数量显著相关（P=0.015）。视盘水肿、头痛、恶心和烦躁（如果术前存在）是颅缝早闭修复后最有可能改善的特征。视神经或视盘异常、喂养困难、癫痫发作和需要戴眼镜则最不可能改善。
接受颅缝早闭手术的年龄较大的儿童有更多改善的症状。提示 ICP 升高的典型特征比发育困难和多因素原因更有可能改善。这些发现可能有助于在有症状的儿童中考虑颅缝早闭修复。
