Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus Medical Center, Room Ee15.91, 2040, 3000 CA, Rotterdam, the Netherlands.
Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands.
Childs Nerv Syst. 2023 Jan;39(1):211-220. doi: 10.1007/s00381-022-05629-x. Epub 2022 Sep 2.
Stagnation of skull growth is correlated with papilledema in craniosynostosis. In this retrospective cohort study, we describe the postoperative skull growth after surgical correction for sagittal synostosis and its relation to the development of papilledema.
Patients with isolated sagittal synostosis at our center between 2005 and 2012 were included. Occipitofrontal circumference (OFC) was analyzed, at 3 time points (preoperative, 2 years postoperative, and last OFC measurement) and 3 phases (initial postoperative growth, long-term growth, and overall growth), and related to papilledema on fundoscopy.
In total, 163 patients were included. The first time interval showed a decline in skull growth, with subsequent stabilization at long term. Papilledema occurred postoperatively in 10 patients. In these patients, the OFC at 2 years and at last follow-up (T3) were significantly smaller than in patients without papilledema. A larger OFC resulted in a decreased odds of developing papilledema at both postoperative time points (at T2 (OR = 0.40, p = 0.01) and at T3 (OR 0.29, p < 0.001)). Sensitivity and specificity analysis indicated that an OFC below 0.25 SD at T2 (sensitivity 90%, specificity 65%) and below 0.49 at T3 (sensitivity 100%, specificity 60%) are related to the occurrence of papilledema.
A small OFC is correlated with the occurrence of papilledema. A decline in OFC within 2 years postoperatively is common in sagittal synostosis and is acceptable up to a value of 0.25SD. Patients with an OFC at last follow-up of less than 0.5SD are at risk for developing papilledema.
颅骨生长停滞与颅缝早闭中的视乳头水肿相关。在这项回顾性队列研究中，我们描述了矢状缝早闭手术后的术后颅骨生长情况及其与视乳头水肿发展的关系。
纳入了我们中心在 2005 年至 2012 年期间患有单纯矢状缝早闭的患者。分析了头围（OFC），在 3 个时间点（术前、术后 2 年和最后一次 OFC 测量）和 3 个阶段（初始术后生长、长期生长和整体生长），并与眼底镜检查中的视乳头水肿相关。
共纳入 163 例患者。第一个时间间隔显示颅骨生长下降，随后长期稳定。10 例患者术后出现视乳头水肿。在这些患者中，术后 2 年和最后一次随访（T3）的 OFC 明显小于无视乳头水肿的患者。较大的 OFC 使术后两个时间点（T2（OR=0.40，p=0.01）和 T3（OR 0.29，p<0.001））发生视乳头水肿的几率降低。敏感性和特异性分析表明，T2 时 OFC 低于 0.25SD（敏感性 90%，特异性 65%）和 T3 时低于 0.49（敏感性 100%，特异性 60%）与视乳头水肿的发生相关。
较小的 OFC 与视乳头水肿的发生相关。矢状缝早闭术后 2 年内 OFC 下降是常见的，在低于 0.25SD 时是可以接受的。最后一次随访时 OFC 小于 0.5SD 的患者有发生视乳头水肿的风险。
