Cohen S R, de Chalain T M, Burstein F D, Hudgins R, Boydston W
Division of Plastic and Reconstructive Surgery, Scottish Rite Children's Medical Center, Atlanta, GA 30342, USA.
Ann Plast Surg. 1995 Dec;35(6):627-30; discussion 631-2.
We describe a technique for early correction of the so-called towering skull deformity, or turribrachycephaly. The technique makes use of the natural elasticity and plasticity of cranial bone, and it is best applied during the first year of life. Surgery consist of routine exposure of the cranial bone via a coronal incision. The frontal bone flap is elevated and removed. On either side, a bony osteotomy is then made, commencing low down in the temporal region and running posteriorly and superiorly toward the occiput. This approach leaves a superior bone flap, which may be left attached to the occipital bone via a flexible posterior hinge region, or completely detached by continuing the osteotomy across the midline. After the osteotomy, the bone flap is elevated up to the sagittal sinus on either side of the midline. The bone flap is not removed, but pushed down, compressing the brain along the craniocaudal axis. The lateral edge of the flap overlaps the temporal bone, and it can be fixed in the desired position by means of simple positional screws or Vicryl sutures. A standard fronto-orbital advancement is performed prior to lowering the skull vault, which permits the brain to be moved down and forward, filling the dead space in the anterior cranial fossa. The frontal bone flap is then shaped appropriately and fixed by means of plates and screws to the advanced fronto-orbital bar. Posteriorly, the frontal lobe is left "floating." To date, we have performed this technique on 5 patients, and we find it both faster and simpler than other techniques. Short-term results in terms of cranial shape are good. In older infants (> 2 years of age), this technique may not prove useful because of the loss of the loss of plasticity of the bone.
我们描述了一种用于早期矫正所谓高耸颅骨畸形（即塔状短头畸形）的技术。该技术利用颅骨的自然弹性和可塑性，且最好在出生后第一年应用。手术包括通过冠状切口常规暴露颅骨。掀起并移除额骨瓣。然后在两侧进行骨性截骨，从颞部较低位置开始，向后上方朝向枕部延伸。这种方法会留下一个上方骨瓣，该骨瓣可通过灵活的后铰链区与枕骨相连，或者通过在中线处继续截骨而完全分离。截骨后，将骨瓣在中线两侧向上掀起至矢状窦。骨瓣不被移除，而是向下推，沿颅尾轴压缩大脑。骨瓣的外侧边缘与颞骨重叠，可通过简单的定位螺钉或薇乔缝线固定在所需位置。在降低颅顶之前进行标准的额眶前移，这使得大脑能够向下向前移动，填充前颅窝的死腔。然后将额骨瓣适当塑形，并用钢板和螺钉固定到前移的额眶杆上。在后方，额叶保持“浮动”状态。迄今为止，我们已对5例患者实施了该技术，发现它比其他技术更快且更简单。就颅骨形状而言，短期效果良好。对于年龄较大的婴儿（>2岁），由于骨质可塑性丧失，该技术可能无用。
