Prezelski Kayla, Blondin Fernandez Mario S, Matsumoto Karen, David Lisa R, Runyan Christopher M, Patel Kamlesh B, Kane Alex A, Hallac Rami R
From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Analytical Imaging and Modeling Center, Children's Health.
Plast Reconstr Surg. 2025 Apr 1;155(4):684-692. doi: 10.1097/PRS.0000000000011685. Epub 2024 Aug 20.
Minimally invasive strip craniectomy is a well-established treatment for sagittal craniosynostosis; however, the temporality of change in head shape has not been assessed. In this study, the authors performed head shape analysis to compare time-series-based clinical outcomes among 3 different surgical techniques across 3 academic centers for the treatment of sagittal craniosynostosis.
Retrospective, longitudinal 3-dimensional (3D) images were collected from patients who underwent surgery for the correction of sagittal craniosynostosis for up to 5 years postoperation. The surgical methods studied include spring-assisted craniectomy, narrow-strip craniectomy plus orthotic helmet therapy, and wide-strip craniectomy with biparietal and bitemporal barrel stave wedge osteotomies plus orthotic helmet therapy. Postoperative 3D images were binned into 6 age groups. Cranial index measurements were calculated on 3D images. The 3D whole-head composite images were generated for each procedure to visually represent longitudinal outcomes.
The median (interquartile range) cranial index measurements at 3- to 5-years postoperative follow-up were 75.9 (73.1 to 78.6) for spring-assisted, 75.9 (75.4 to 78.5) for narrow-strip, and 79.4 (76.4 to 81.9) for wide-strip procedures. The wide-strip cranial index was significantly different from the spring-assisted and narrow-strip groups ( P < 0.001). Concerning 3D analysis, patients receiving spring-assisted procedures showed normalization of frontal bossing and skull height compared with age-matched controls, whereas patients receiving wide-strip procedures showed greater correction of occipital bulleting. Patients receiving narrow-strip procedures had intermediate results between these outcomes.
There was no statistically significant regression in longitudinal cranial index measurements across the 3 techniques aimed at treating sagittal craniosynostosis. Longitudinal comparison of 3D head shape outcome demonstrated satisfactory correction of scaphocephalic deformity across all 3 surgical groups.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
微创条带颅骨切除术是矢状缝早闭的一种成熟治疗方法；然而，头型变化的时间性尚未得到评估。在本研究中，作者进行了头型分析，以比较3个学术中心采用3种不同手术技术治疗矢状缝早闭的基于时间序列的临床结果。
收集接受矢状缝早闭矫正手术患者术后长达5年的回顾性纵向三维（3D）图像。研究的手术方法包括弹簧辅助颅骨切除术、窄条颅骨切除术加矫形头盔治疗，以及宽条颅骨切除术联合双额颞桶状骨条楔形截骨术加矫形头盔治疗。术后3D图像被分为6个年龄组。在3D图像上计算颅骨指数测量值。为每个手术生成3D全头复合图像，以直观呈现纵向结果。
术后3至5年随访时，弹簧辅助组的颅骨指数测量值中位数（四分位间距）为75.9（73.1至78.6），窄条组为75.9（75.4至78.5），宽条组为79.4（76.4至81.9）。宽条组的颅骨指数与弹簧辅助组和窄条组有显著差异（P<0.001）。关于3D分析，接受弹簧辅助手术的患者与年龄匹配的对照组相比，额部隆起和颅骨高度恢复正常，而接受宽条手术的患者枕部隆起矫正程度更大。接受窄条手术的患者结果介于两者之间。
旨在治疗矢状缝早闭的3种技术在纵向颅骨指数测量上无统计学显著回归。3D头型结果的纵向比较表明，所有3个手术组对舟状头畸形的矫正效果均令人满意。
临床问题/证据水平：治疗性，III级
