1Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.
2Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California.
J Neurosurg Pediatr. 2024 May 10;34(2):182-189. doi: 10.3171/2024.2.PEDS23521. Print 2024 Aug 1.
As many as 5% of normocephalic children may have a prematurely fused sagittal suture, yet the clinical significance and best course of management of this finding remain unclear. Providers in the Synostosis Research Group were surveyed to create a multicenter consensus on an optimal treatment and monitoring algorithm for this condition.
A four-round modified Delphi method was utilized. The first two rounds consisted of anonymous surveys distributed to 10 neurosurgeons and 9 plastic surgeons with expertise in craniosynostosis across 9 institutions, and presented 3 patients (aged 3 years, 2 years, and 2 months) with incidentally discovered fused sagittal sutures, normal cephalic indices, and no parietal dysmorphology. Surgeons were queried about their preferred term for this entity and how best to manage these patients. Results were synthesized to create a treatment algorithm. The third and fourth feedback rounds consisted of open discussion of the algorithm until no further concerns arose.
Most surgeons preferred the term "premature fusion of the sagittal suture" (93%). At the conclusion of the final round, all surgeons agreed to not operate on the 3- and 2-year-old patients unless symptoms of intracranial hypertension or papilledema were present. In contrast, 50% preferred to operate on the 2-month-old. However, all agreed to utilize shared decision-making, taking into account any concerns about future head shape and neurodevelopment. Panelists agreed that patients over 18 months of age without signs or symptoms suggesting elevated intracranial pressure (ICP) should not undergo surgical treatment.
Through the Delphi method, a consensus regarding management of premature fusion of the sagittal suture was obtained from a panel of North American craniofacial surgeons. Without signs or symptoms of ICP elevation, surgery is not recommended in patients over 18 months of age. However, for children younger than 18 months, surgery should be discussed with caregivers using a shared decision-making process.
多达 5%的正常头围儿童可能存在矢状缝过早融合，但这种发现的临床意义和最佳管理方法仍不清楚。对颅缝早闭研究小组的医生进行了调查，以就这种情况制定出多中心的最佳治疗和监测方案的共识。
采用四轮改良 Delphi 法。前两轮包括向 9 家机构的 10 名神经外科医生和 9 名颅面整形外科医生分发的匿名调查，介绍了 3 名患有偶然发现的矢状缝过早融合、正常头颅指数且无顶骨畸形的 3 岁、2 岁和 2 个月大的患者。询问外科医生他们对该实体的首选术语以及如何最好地管理这些患者。结果进行了综合，制定了治疗方案。第三轮和第四轮反馈轮次则是对该方案进行公开讨论，直到没有进一步的问题出现。
大多数外科医生更喜欢使用“矢状缝过早融合”这一术语（93%）。在最后一轮结束时，所有外科医生都同意，除非存在颅内压升高或视盘水肿的症状，否则不会对 3 岁和 2 岁的患者进行手术。相比之下，50%的医生更倾向于对 2 个月大的患者进行手术。然而，所有医生都同意采用共同决策，考虑到对未来头部形状和神经发育的任何担忧。小组成员一致认为，18 个月以上没有迹象或症状表明颅内压升高（ICP）的患者不应该进行手术治疗。
通过 Delphi 法，从一组北美颅面外科医生那里获得了关于矢状缝过早融合管理的共识。对于 ICP 升高没有迹象或症状的患者，不建议在 18 个月以上的患者中进行手术。然而，对于 18 个月以下的儿童，应与照顾者使用共同决策过程进行讨论。
