From the Departments of Neurosurgery.
Radiology and Nuclear Medicine.
Plast Reconstr Surg. 2023 Oct 1;152(4):675e-688e. doi: 10.1097/PRS.0000000000010441. Epub 2023 Mar 22.
The aim of this study was to compare three surgical interventions for correction of sagittal synostosis-frontobiparietal remodeling (FBR), extended strip craniotomy (ESC), and spring-assisted correction (SAC)-based on three-dimensional (3D) photogrammetry and operation characteristics.
Patients who were born between 1991 and 2019 and diagnosed with nonsyndromic sagittal synostosis who underwent FBR, ESC, or SAC and had at least one postoperative 3D photogrammetry image taken during one of six follow-up appointments until age 6 were considered for this study. Operative characteristics, postoperative complications, reinterventions, and presence of intracranial hypertension were collected. To assess cranial growth, orthogonal cranial slices and 3D photocephalometric measurements were extracted automatically and evaluated from 3D photogrammetry images.
A total of 322 postoperative 3D images from 218 patients were included. After correcting for age and sex, no significant differences were observed in 3D photocephalometric measurements. Mean cranial shapes suggested that postoperative growth and shape gradually normalized with higher occipitofrontal head circumference and intracranial volume values compared with normal values, regardless of type of surgery. Flattening of the vertex seems to persist after surgical correction. The authors' cranial 3D mesh processing tool has been made publicly available as a part of this study.
The findings suggest that until age 6, there are no significant differences among the FBR, ESC, and SAC in their ability to correct sagittal synostosis with regard to 3D photocephalometric measurements. Therefore, efforts should be made to ensure early diagnosis so that minimally invasive surgery is a viable treatment option.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究旨在通过三维（3D）摄影测量和手术特点，比较三种用于矫正矢状缝早闭的手术干预措施——额眶顶骨重塑（FBR）、扩展条状颅骨切开术（ESC）和弹簧辅助矫正（SAC）。
本研究纳入了 1991 年至 2019 年间出生、诊断为非综合征性矢状缝早闭、接受 FBR、ESC 或 SAC 治疗且至少有一次术后三维摄影测量图像的患者。收集了手术特点、术后并发症、再次手术和颅内压增高的情况。为了评估颅骨生长情况，从三维摄影测量图像中自动提取并评估了正交颅骨切片和三维头颅测量值。
共纳入了 218 例患者的 322 张术后三维图像。在校正年龄和性别后，三种手术方式在三维头颅测量值上无显著差异。平均颅骨形状表明，无论手术类型如何，与正常值相比，术后生长和形状逐渐正常化，表现为更高的头围和颅内体积值。术后顶点变平似乎持续存在。作者的颅 3D 网格处理工具已作为本研究的一部分公开发布。
研究结果表明，在 6 岁之前，FBR、ESC 和 SAC 在矫正矢状缝早闭方面的 3D 头颅测量值上没有显著差异。因此，应努力确保早期诊断，以便微创外科成为可行的治疗选择。
临床问题/证据水平：治疗，III。
