Cleft and Craniofacial SA, Women's and Children's Hospital, North Adelaide, Adelaide, SA, Australia.
Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Childs Nerv Syst. 2023 Dec;39(12):3349-3359. doi: 10.1007/s00381-023-06147-0. Epub 2023 Sep 12.
The cloverleaf skull deformity remains among the most complicated craniofacial conditions to successfully manage. Many cases achieve largely unsatisfactory outcomes due to the requirement for frequent reoperation on the cranial vault and failure to deal with all the elements of the craniofaciostenosis in a timely fashion. Early cranial vault surgery without addressing the cranial base deformity and its attendant cerebrospinal fluid flow changes is invariably challenging and disappointing. A recent focus on the expansion of the posterior cranial vault as a primary procedure with the greater volume change allows a delay in fronto-orbital advancement and reduced need for repeat surgery. We herein describe three cases of complex multisuture craniosynostosis with cloverleaf skull deformity who underwent neonatal posterior cranial vault decompression along with foramen magnum decompression. Our report examines the safety and rationale for this pre-emptive surgical approach to simultaneously deal with the cranial vault and craniocervical junction abnormalities and thus change the early trajectory of these complex cases.
三叶形颅骨畸形仍然是最难成功治疗的颅面畸形之一。由于需要频繁地对颅顶进行再次手术，并且未能及时处理颅面狭窄的所有元素，许多病例的治疗结果都极不理想。如果不在早期解决颅底畸形及其伴随的脑脊液流动变化，单纯进行颅盖骨手术，结果总是充满挑战且令人失望。最近，人们将重点放在通过增加颅后窝的容积来作为主要手术，从而延迟额眶部的推进，并减少重复手术的需要。我们在此描述了三例复杂的多缝颅缝早闭合并三叶形颅骨畸形的患者，他们接受了新生儿颅后窝减压术和枕骨大孔减压术。我们的报告探讨了这种先发制人的手术方法的安全性和基本原理，该方法可同时处理颅顶和颅颈交界区的异常，从而改变这些复杂病例的早期治疗轨迹。
