1Division of Pediatric Plastic Surgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea.
2Division of Plastic Surgery, Children's National Medical Center, Washington, DC.
J Neurosurg Pediatr. 2024 Aug 16;34(5):519-525. doi: 10.3171/2024.6.PEDS24137. Print 2024 Nov 1.
The objective of this study was to investigate the longitudinal changes in cranial growth following fronto-orbital advancement (FOA) surgery in patients with unilateral and bilateral coronal craniosynostosis.
This retrospective review analyzed head circumference (HC) and CT data during preoperative (T0), immediate postoperative (T1), and final follow-up (T2) visits in 40 patients (23 female, 17 male) who underwent FOA using either the open approach or distraction osteogenesis (DO) between 1987 and 2018. The mean follow-up period was 90.62 months. The z-scores of HC, CT-based intracranial volume, anteroposterior diameter (APD), biparietal diameter (BPD), and cranial height (CH) were calculated using sex- and age-specific standards. Logistic regression analysis was performed.
While the z-scores of HC, intracranial volume, and BPD remained within the normal range, the z-scores of APD fluctuated between -2 and -1, and the z-scores of CH were > 2, indicating a substantial elevation compared with norms from T0 to T2. Age at surgery significantly influenced the z-scores of HC, BPD, and CH at T2 (all p < 0.05). Delayed surgical timing was correlated with increased BPD and CH z-scores from T1 to T2 (p = 0.007 and 0.019, respectively). The DO for FOA resulted in elevated HC z-scores at T2 and increased APD from T0 to T1, followed by a significant APD relapse from T1 to T2.
These findings suggest that delayed surgical timing may support better cranial growth, as indicated by increased HC at long-term follow-up. However, delayed timing is also associated with worsening abnormally elevated CH. Despite the immediate APD expansion and long-term HC increase with DO, potential relapse warrants caution. While intentional overcorrection of APD is recommended, careful consideration of surgical timing and planning is essential.
本研究旨在探讨单侧和双侧冠状缝早闭患者行额眶前移（FOA）手术后颅部生长的纵向变化。
本回顾性研究分析了 1987 年至 2018 年间采用开放式或牵引成骨术（DO）行 FOA 的 40 例患者（女 23 例，男 17 例）的术前（T0）、即刻术后（T1）和最终随访（T2）时的头围（HC）和 CT 数据。平均随访时间为 90.62 个月。采用性别和年龄特异性标准计算 HC、基于 CT 的颅内容积、前后径（APD）、双径（BPD）和颅高（CH）的 Z 分数。采用逻辑回归分析。
虽然 HC、颅内容积和 BPD 的 Z 分数仍在正常范围内，但 APD 的 Z 分数在-2 至-1 之间波动，CH 的 Z 分数>2，与 T0 至 T2 时的正常值相比显著升高。手术年龄显著影响 T2 时 HC、BPD 和 CH 的 Z 分数（均 p<0.05）。手术时间延迟与 T1 至 T2 时 BPD 和 CH Z 分数的增加相关（p=0.007 和 0.019）。FOA 的 DO 导致 T2 时 HC 的 Z 分数升高，T0 至 T1 时 APD 增加，随后 T1 至 T2 时 APD 显著复发。
这些发现表明，手术时间延迟可能会促进更好的颅部生长，这表现在长期随访时 HC 的增加。然而，延迟也与 CH 异常升高的恶化有关。尽管 DO 可即刻扩大 APD 并长期增加 HC，但潜在的复发仍需警惕。虽然推荐对 APD 进行有意的过度矫正，但手术时机和计划的仔细考虑至关重要。
