Posnick J C, Armstrong D, Bite U
Division of Plastic Surgery, Georgetown University Medical Center, Washington, D.C., USA.
Plast Reconstr Surg. 1995 Aug;96(2):299-309; discussion 310-5.
This study applied a proven method for obtaining intracranial volume measurements using CT scans to (1) measure the intracranial volume of a consecutive series of children with either metopic or sagittal synostosis prior to any craniofacial procedure, (2) perform a standard cranio-orbital operation in each child, follow them longitudinally, and remeasure their intracranial volume 1 year later, and (3) compare their intracranial volumes with those of an age- and gender-matched cohort and review their cranial growth velocity. The study included 18 children who presented sequentially with untreated isolated nonsyndromic sagittal (n = 8) and metopic (n = 10) synostosis between 1987 and 1990 and who subsequently underwent cranio-orbital reconstruction by the senior author (Posnick) in conjunction with a pediatric neurosurgeon. The primary method of osteotomy and bone-graft fixation varied (i.e., wires, miniplates and microplates and screws). The series included 5 females and 13 males with an average age at the time of operation of 27 months (range 6 to 87 months). The postoperative clinical follow-up ranged from 13 to 47 months at the close of the study. Comparison of our patients' preoperative intracranial volumes with age- and gender-matched volumes available through Lichtenberg showed that 16 of 18 (89 percent) had volumes at or greater than the mean, with 44 percent (7 of 16) exceeding 2 standard deviations above the mean. When comparing our patients' late postoperative volumes with the Lichtenberg normative measurements, 94 percent achieved values at or greater than the mean. All patients achieved increased intracranial volume in association with the surgery performed and the time that lapsed between scan intervals. The majority of our patients (16 of 18) followed an intracranial volume growth curve that closely approximated the norm but with a starting point determined by the preoperative value. Two of 18 followed a growth curve that exceeded the rate of expansion expected for normal children. Our findings suggest that premature closure of either the sagittal or metopic suture does not result in diminished intracranial volume prior to or after the cranio-orbital procedures carried out in childhood. For the majority of the children in our study, both the preoperative intracranial volume and the rate of cranial expansion approximated or surpassed that of children without synostosis. The surgical techniques of skull and upper orbital reshaping with varied forms of osteotomy and graft fixation did not result in a global form of growth restriction. These findings are contrary to standard thinking about the biologic effects of craniosynostosis and raise new questions about our rationale for treatment.
本研究应用一种经证实的利用CT扫描获取颅内体积测量值的方法，以：(1) 在任何颅面手术前测量一系列连续性的患有冠状缝或矢状缝早闭的儿童的颅内体积；(2) 对每个儿童进行标准的颅眶手术，对他们进行纵向随访，并在1年后重新测量其颅内体积；(3) 将他们的颅内体积与年龄和性别匹配的队列进行比较，并评估其颅骨生长速度。该研究纳入了18名儿童，他们在1987年至1990年间依次出现未经治疗的孤立性非综合征性矢状缝（n = 8）和冠状缝（n = 10）早闭，随后由资深作者（波斯尼克）联合一名儿科神经外科医生为他们进行了颅眶重建手术。截骨术和骨移植固定的主要方法各不相同（即钢丝、微型钢板和微型钛板及螺钉）。该系列包括5名女性和13名男性，手术时的平均年龄为27个月（范围6至87个月）。在研究结束时，术后临床随访时间为13至47个月。将我们患者术前的颅内体积与通过利希滕贝格获得的年龄和性别匹配的体积进行比较，结果显示18名患者中有16名（89%）的体积等于或大于平均值，其中44%（16名中的7名）超过平均值2个标准差以上。将我们患者术后晚期的体积与利希滕贝格的标准测量值进行比较时，94%的患者达到或大于平均值。所有患者均因所进行的手术以及扫描间隔之间经过的时间而使颅内体积增加。我们的大多数患者（18名中的16名）遵循的颅内体积生长曲线与正常情况非常接近，但起点由术前值决定。18名患者中有2名遵循的生长曲线超过了正常儿童预期的扩张速度。我们的研究结果表明，在儿童期进行颅眶手术之前或之后，矢状缝或冠状缝过早闭合不会导致颅内体积减小。对于我们研究中的大多数儿童，术前颅内体积和颅骨扩张速度均接近或超过无缝早闭的儿童。采用各种截骨术和移植固定形式进行颅骨和眶上部重塑的手术技术并未导致整体形式的生长受限。这些发现与关于颅缝早闭生物学效应的标准观点相反，并对我们的治疗理论提出了新的问题。
