da Costa Marcos, Pinheiro Vitoria, Borges Pedro G L B, Cavalheiro Sergio
Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo , SP , Brazil.
School of Medicine, Ninth of July University, São Paulo , SP, Brazil.
Neurosurgery. 2024 Dec 3;97(1):28-44. doi: 10.1227/neu.0000000000003294.
Scaphocephaly is a craniofacial deformity caused by the premature fusion of the sagittal suture, which can affect skull growth and shape. For decades, surgical treatment or craniosynostosis has involved open procedures, ranging from the removal of a single suture to complex cranial remodeling techniques with large skin incisions. Since the 1990s, endoscopic approaches have emerged as potentially less invasive options. This study aimed to evaluate the efficacy of and differences between endoscopic scaphocephaly correction techniques.
A comprehensive search was conducted on PubMed, Embase, Web of Science, and Scopus for clinical trials and observational studies analyzing endoscopic correction of scaphocephaly and describing the procedure. The outcomes analyzed included pre- and postoperative cephalic indexes, operation time, blood loss, number of transfusions, complications, and subgroup analysis.
Thirty-two studies involving 1566 patients (mean age at the time of surgery: 3.3 months) were included. Overall, the cephalic index showed a significant increase in the mean difference of 7.58 (95% CI 6.35-8.80; P < .01), and when analyzed by subgroups based on the size of the removed strip (≤2 and >2 cm), there was no significant difference in the cephalic index. In addition, the analysis of lateral osteotomies showed no difference in CI between the subgroups.
Our results suggest that less invasive techniques, involving smaller incisions and excisions, can achieve comparable success with traditional techniques. These findings have significant implications for clinical practice, underscoring the importance of exploring less invasive options for scaphocephaly correction to improve patient outcomes and reduce morbidity.
舟状头畸形是一种由矢状缝过早融合引起的颅面畸形，会影响颅骨生长和形状。几十年来，手术治疗或颅骨缝早闭的治疗一直采用开放手术，从单一缝线切除到采用大皮肤切口的复杂颅骨重塑技术不等。自20世纪90年代以来，内镜手术方法已成为潜在的侵入性较小的选择。本研究旨在评估内镜下舟状头畸形矫正技术的疗效及差异。
对PubMed、Embase、Web of Science和Scopus进行全面检索，以查找分析内镜下舟状头畸形矫正并描述该手术的临床试验和观察性研究。分析的结果包括术前和术后的头指数、手术时间、失血量、输血次数、并发症及亚组分析。
纳入了32项研究，共1566例患者（手术时的平均年龄为3.3个月）。总体而言，头指数平均差异显著增加7.58（95%CI 6.35 - 8.80；P <.01），按切除条带大小（≤2 cm和>2 cm）进行亚组分析时，头指数无显著差异。此外，外侧截骨术的分析显示各亚组间头指数无差异。
我们的结果表明，涉及较小切口和切除范围的侵入性较小的技术与传统技术可取得相当的成功。这些发现对临床实践具有重要意义，强调了探索侵入性较小的舟状头畸形矫正方法以改善患者预后和降低发病率的重要性。
