Johnson Emily A, Koller Gretchen M, Jafrani Ryan, Patel Kamlesh, Naidoo Sybill, Strahle Jennifer M
Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Department of Plastics & Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Cleft Palate Craniofac J. 2025 Mar;62(3):513-518. doi: 10.1177/10556656231214125. Epub 2024 Jan 9.
ObjectiveTo evaluate the safety and efficacy of helmet therapy for deformational plagiocephaly in patients with shunted hydrocephalus.DesignRetrospective chart review.SettingInstitutional, tertiary-care hospital.PatientsAll patients at St. Louis Children's Hospital between 2014 and 2021 with shunted hydrocephalus who underwent helmet therapy for deformational plagiocephaly.InterventionsHelmet therapy.Main Outcome MeasuresCranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), and cephalic index (CI) were measured before and after completion of helmet therapy.ResultsThere were 37 patients with shunted hydrocephalus and documented deformational plagiocephaly. Twelve were managed with helmet therapy. Average age at helmeting initiation and time between shunt placement and helmeting initiation was 5.8 and 4.6 months, respectively. Average CVA, CVAI, and CI at helmeting initiation and termination was 11.6, 7.98, and 85.2, and 6.95, 4.49, and 83.7, respectively. Average duration of helmeting was 3.7 months. CVA and CVAI were significantly lower after helmeting ( = .0028 and .0021) and 11/12 patients had overall improvement in plagiocephaly.ConclusionsHelmet therapy appears to be a safe and efficacious management strategy for deformational plagiocephaly in patients with shunted hydrocephalus. Despite the occasional need for additional fittings and surveillance beyond the normal schedule, in all cases appropriately fitting helmets were achieved and no major adverse events occurred. This cohort represents a proof of principle for the safety and efficacy of helmet therapy in patients with shunted hydrocephalus. Further work in larger prospective cohorts is needed to confirm these initial findings.
目的
评估头盔疗法治疗分流性脑积水患儿变形性斜头畸形的安全性和有效性。
设计
回顾性病历审查。
地点
三级医疗机构。
患者
2014年至2021年期间在圣路易斯儿童医院接受头盔疗法治疗变形性斜头畸形的所有分流性脑积水患儿。
干预措施
头盔疗法。
主要观察指标
在头盔疗法完成前后测量颅穹不对称（CVA）、颅穹不对称指数（CVAI）和头指数（CI）。
结果
共有37例分流性脑积水且有记录的变形性斜头畸形患儿。其中12例接受了头盔疗法。开始佩戴头盔时的平均年龄以及分流置入与开始佩戴头盔之间的平均时间分别为5.8个月和4.6个月。开始佩戴头盔时及结束时的平均CVA、CVAI和CI分别为11.6、7.98和85.2，以及6.95、4.49和83.7。平均佩戴头盔时间为3.7个月。佩戴头盔后CVA和CVAI显著降低（P = 0.0028和0.0021），12例患者中有11例斜头畸形总体改善。
结论
头盔疗法似乎是治疗分流性脑积水患儿变形性斜头畸形的一种安全有效的管理策略。尽管偶尔需要在正常计划之外进行额外的调整和监测，但所有病例均成功佩戴了合适的头盔，且未发生重大不良事件。这一队列证明了头盔疗法治疗分流性脑积水患儿的安全性和有效性原则。需要在更大的前瞻性队列中开展进一步研究以证实这些初步发现。
