Rückschloß Thomas, Zittel Sven, Hassanein Elhassan, El Damaty Ahmed, Krieg Sandro M, Ristow Oliver, Hoffmann Jürgen, Engel Michael
Departments of1Cranio- and Maxillofacial Surgery and.
2Department of Endodontics, Düsseldorf University Hospital, Düsseldorf, Germany.
Neurosurg Focus. 2025 Jan 1;58(1):E7. doi: 10.3171/2024.10.FOCUS24582.
Isolated craniosynostosis of the sagittal suture results in scaphocephaly characterized by a long, narrow skull. Surgical correction of this condition remains debated, particularly regarding the necessity of directly addressing frontal bossing. This study aimed to assess the effectiveness of extended strip craniectomy combined with bilateral barrel staving in improving cranial morphology without direct intervention on the forehead.
This retrospective study included 81 patients diagnosed with isolated sagittal synostosis, treated surgically at an average age of 5.3 months. Three-dimensional photogrammetric scans were obtained 1 day before surgery and 14 days, 3 months, and 12 months postoperatively. The bossing angle, nasofrontal angle, cephalic index, and vertex ratio were analyzed. A control group of age-matched healthy children was used for comparison.
Significant reductions in the bossing angle were observed from preoperatively to 12 months postoperatively, indicating that the intervention contributed to a more normalized cranial shape. The cephalic index increased significantly postoperatively, although it remained lower than that of the control group. The nasofrontal angle remained stable across all time points, with minimal differences between the study and control groups. The vertex ratio decreased significantly over time, suggesting a balanced cranial shape. However, persistent differences between the study and control groups suggest that the intervention did not fully normalize cranial morphology in the short to midterm.
Extended strip craniectomy with bilateral barrel staving, while effective in improving certain aspects of cranial morphology, may not fully equalize cranial shape within the short to midterm. The use of 3D photogrammetry as a noninvasive method for assessing cranial changes is validated in this study and holds promise for broader applications in craniofacial surgery.
矢状缝孤立性颅缝早闭导致舟状头畸形，其特征为颅骨长而窄。这种情况的手术矫正仍存在争议，特别是在是否有必要直接处理额部隆突方面。本研究旨在评估扩大条带颅骨切除术联合双侧桶状劈开术在不直接干预前额的情况下改善颅骨形态的有效性。
这项回顾性研究纳入了81例诊断为孤立性矢状缝颅缝早闭的患者，平均手术年龄为5.3个月。在手术前1天以及术后14天、3个月和12个月进行三维摄影测量扫描。分析额部隆突角、鼻额角、头指数和顶点比率。使用年龄匹配的健康儿童作为对照组进行比较。
从术前到术后12个月观察到额部隆突角显著减小，表明该干预有助于使颅骨形状更趋于正常。术后头指数显著增加，尽管仍低于对照组。鼻额角在所有时间点均保持稳定，研究组与对照组之间差异极小。顶点比率随时间显著降低，表明颅骨形状趋于平衡。然而，研究组与对照组之间持续存在差异，这表明该干预在短期至中期内并未使颅骨形态完全正常化。
扩大条带颅骨切除术联合双侧桶状劈开术虽然在改善颅骨形态的某些方面有效，但在短期至中期内可能无法使颅骨形状完全均衡。本研究验证了使用三维摄影测量作为评估颅骨变化的非侵入性方法的有效性，并且在颅面外科手术中有更广泛应用的前景。
