Shuster B A, Norbash A M, Schendel S A
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Calif., USA.
Plast Reconstr Surg. 1995 Oct;96(5):1012-9. doi: 10.1097/00006534-199510000-00002.
Craniosynostosis following ventricular shunting procedures for hydrocephalus has become a recognized complication of shunting procedures. Secondary synostosis results from a decrease in intracranial volume leading to collapse of the cranial vault. Since this represents a distinct etiopathogenesis different from that typically involved, the surgical approach should be altered. Eight patients with secondary scaphocephaly underwent surgical reconstruction. The clinical data and radiographic studies were reviewed for these patients. The surgical approach consisted of sagittal or parasagittal strip craniectomies, lateral osteotomies with bone-flap expansion, occipital and frontal remodeling as needed, and the application of rigid fixation to maintain contour and prevent recurrent collapse of the cranial vault. Patient follow-up ranged from 3 to 37 months. Five of these patients were premature infants, an association not previously recognized in the literature. Satisfactory results were obtained in all patients. Keeping the craniectomy sites parent and achieving a more normal cranial contour through cranial remodeling have provided good results in this population.
脑积水脑室分流术后的颅骨缝早闭已成为分流手术公认的并发症。继发性颅骨缝早闭是由颅内体积减小导致颅顶塌陷引起的。由于这代表了一种与典型情况不同的独特发病机制，手术方法应予以改变。8例继发性舟状头畸形患者接受了手术重建。对这些患者的临床资料和影像学研究进行了回顾。手术方法包括矢状或旁矢状条带颅骨切除术、带骨瓣扩张的外侧截骨术、根据需要进行枕部和额部重塑，以及应用刚性固定以维持轮廓并防止颅顶反复塌陷。患者随访时间为3至37个月。其中5例患者为早产儿，这一关联在以往文献中未被认识到。所有患者均取得了满意的结果。保持颅骨切除部位开放并通过颅骨重塑实现更正常的颅骨轮廓，在这一人群中取得了良好的效果。
