Burstein F D, Hudgins R J, Cohen S R, Boydston W R
Department of Plastic Surgery, Scottish Rite Children's Medical Center, Atlanta, Georgia.
J Craniofac Surg. 1994 Sep;5(4):228-35; discussion 236. doi: 10.1097/00001665-199409000-00006.
Sagittal synostosis may result in severe skull deformities. Characteristic components of the deformity include extreme elongation, frontal and occipital bossing, temporal pinching, and angulatory apical skull deformation. Conventional strip craniectomy often fails to correct these complex problems completely in severe early or late cases of sagittal synostosis. Techniques for total calvarial vault reconstruction have previously been reported, but a single large series has not been presented. Eighteen consecutive patients ranging in age from 3 months to 5 years (mean = 12 months) with severe early and late scaphocephalic skull deformities underwent total calvarial vault reshaping. All children required transfusions ranging from 250 to 1,100 mL. Operative times averaged 6 hours, and hospital stay ranged from 4 to 7 days. There was no perioperative mortality. Two patients experienced transient syndrome of inappropriate secretion of antidiuretic hormone, which responded to fluid restriction. One patient was noted to have a 2-cm parietal craniectomy defect 9 months after operation. Microscrews, which were used in all 18 patients, had to be removed in 2 patients when they became palpable. Excellent aesthetic results were noted in all 18 patients up to 36 months of follow-up.
矢状缝早闭可能导致严重的颅骨畸形。该畸形的特征性表现包括极度伸长、额部和枕部隆起、颞部变窄以及颅骨顶部成角变形。在矢状缝早闭的严重早期或晚期病例中，传统的条状颅骨切除术往往无法完全纠正这些复杂问题。此前已有关于全颅盖重建技术的报道，但尚未有单一的大型系列病例呈现。18例年龄在3个月至5岁（平均12个月）的连续患者，患有严重的早期和晚期舟状头颅骨畸形，接受了全颅盖重塑手术。所有患儿均需要250至1100毫升的输血。手术时间平均为6小时，住院时间为4至7天。围手术期无死亡病例。2例患者出现了抗利尿激素分泌不当综合征，通过限制液体摄入得到缓解。1例患者在术后9个月被发现有2厘米的顶骨颅骨切除缺损。所有18例患者均使用了微型螺钉，其中2例患者的微型螺钉在可触及后不得不取出。在长达36个月的随访中，所有18例患者均取得了良好的美学效果。
