Czorny A, Yettou H, Forlodou P, Stricker M
Service de Neurochirurgie, Besançon.
Neurochirurgie. 1995;41(4):295-314.
The deformation of the posterior part of the skull (occipito-vertebral region), induced directly or indirectly, occurs in numerous pathological situations. Its significance is frequently overlooked. Lesions of the cranial content, alterations of the lambdoid suture or other premature synostosis, abnormal constraint related to posture or to muscular activity can modify the posterior curvature of the skull, generally flattening it. The authors propose a classification based on three points: -Intracranial pathology: alterations of the brain or CSF fluid can induce either insufficient (microencephaly) or excessive (hydrocephalus, Dandy Walker or Arnold Chiari malformations) expansion. -Bone pathology: craniosynostosis: sagittal synostosis (scaphocephaly) induces a bulging and coronal synostosis a flatness of the posterior skull. Bilateral premature lambdoid synostosis (pachycephaly) produces total flatness of the back of the skull. -Extrinsic pathology: dysmorphism is often asymmetrical and results from extracranial mechanical application dysfunction such as inborn torticollis, cervical spine pathology (Klippel-Feil syndrome), or prolonged decubitus during the first year of life. The authors describe a personal technique for correcting this dysmorphism: the turned biparietal flap transposition. The back of the skull is remodelled (either asymmetrical or bilateral flatness), and patients with no need for a helmet can lie on their backs immediately after the operation.
颅骨后部（枕颈区域）直接或间接引起的变形在众多病理情况下都会发生。其重要性常常被忽视。颅内内容物病变、人字缝改变或其他过早骨缝闭合、与姿势或肌肉活动相关的异常约束均可改变颅骨的后曲率，通常使其变平。作者提出了一种基于三点的分类方法：-颅内病变：脑或脑脊液的改变可导致扩张不足（小头畸形）或过度（脑积水、丹迪·沃克畸形或阿诺德·基亚里畸形）。-骨骼病变：颅骨缝早闭：矢状缝早闭（舟状头畸形）导致颅骨膨隆，冠状缝早闭导致颅骨后部变平。双侧人字缝过早闭合（厚头畸形）导致颅骨后部完全变平。-外部病变：畸形往往不对称，是由颅外机械应用功能障碍引起的，如先天性斜颈、颈椎病变（克利佩尔-费尔综合征）或出生后第一年长期卧床。作者描述了一种矫正这种畸形的个人技术：双侧顶骨皮瓣翻转移位术。对颅骨后部进行重塑（无论是不对称还是双侧变平），术后无需戴头盔的患者可立即仰卧。
