Stelnicki E J, Mooney M P, Losken H W, Zoldos J, Burrows A M, Kapucu R, Siegel M I
Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, MO, USA.
J Craniofac Surg. 1997 Jul;8(4):252-8; discussion 259-61. doi: 10.1097/00001665-199707000-00004.
The present study was designed to assess the utility and validity of standard prenatal ultrasonography in identifying individuals with coronal suture synostosis by examining sutural abnormalities before the development of secondary craniofacial dysmorphologies. An Accusson 128 XP ultrasound machine was used to scan the coronal sutures of 31 twenty-five-day-old fetuses (term = 31 days) from four timed-pregnant New Zealand White rabbits with simple, nonsyndromic craniosynostosis. Each mother was sedated with general anesthesia, and the gravid uterine horns were exposed via a laparotomy procedure. The fetal calvariae were examined using a no. 7 transducer at 7.0 mHz. Each coronal suture was scanned using ultrasonography by first identifying bregma (the anterior fontanelle) at the intersection of the sagittal, interfrontal, and coronal sutures and then following the coronal sutures laterally. Seventeen of the 31 fetuses were diagnosed with unilateral or bilateral coronal suture fusion. In fetuses with synostosis, the suture was echolucent and patent in the midline but then rapidly tapered off to fused bone as it progressed laterally. This finding is in accordance with the natural history of the synostotic foci and coronal suture fusion progression in these rabbits. In addition, the sagittal and interfrontal sutures in each synostotic rabbit appeared wider along their course compared with normal. This reflects early enhanced compensatory transverse growth resulting from the anteroposterior growth restrictions from coronal suture fusion. No other cranial shape abnormalities were recognizable at this stage of fetal development. The validity of the ultrasound diagnoses was tested by direct ex utero inspection of 9 of the 17 synostotic fetuses. Gross morphological examination showed that 8 of 9 rabbit fetuses (89%) had fused coronal sutures. Statistical analysis revealed no significant difference (chi 2 = 0.22, P > 0.05) between the diagnostic accuracy of standard ultrasonography and direct examination. In conclusion, we have shown that standard ultrasonography of the calvarial sutures, in the absence of other craniofacial malformations, may be a feasible method of diagnosing simple, nonsyndromic craniosynostosis in utero, a condition that is typically missed during routine prenatal ultrasonic screening examinations.
本研究旨在通过在继发颅面畸形形成之前检查缝线异常，评估标准产前超声检查在识别冠状缝早闭个体中的实用性和有效性。使用一台Accusson 128 XP超声仪对来自四只定时怀孕的新西兰白兔的31只25日龄胎儿（足月为31天）的冠状缝进行扫描，这些胎儿患有单纯性、非综合征性颅缝早闭。每只母兔均用全身麻醉镇静，通过剖腹手术暴露妊娠子宫角。使用7.0兆赫兹的7号探头检查胎儿颅骨。首先在矢状缝、额间缝和冠状缝的交点处识别前囟（前囟门），然后沿冠状缝向外侧扫描，对每条冠状缝进行超声检查。31只胎儿中有17只被诊断为单侧或双侧冠状缝融合。在患有缝早闭的胎儿中，缝线在中线处呈无回声且通畅，但随着向外侧延伸，迅速变细直至融合成骨。这一发现与这些兔子中缝早闭病灶和冠状缝融合进展的自然史一致。此外，与正常情况相比，每只患有缝早闭的兔子的矢状缝和额间缝在走行过程中显得更宽。这反映了冠状缝融合导致的前后生长受限所引起的早期代偿性横向生长增强。在胎儿发育的这个阶段，没有其他颅骨形状异常可识别。通过对17只患有缝早闭的胎儿中的9只进行直接体外检查，对超声诊断的有效性进行了测试。大体形态学检查显示，9只兔胎儿中有8只（89%）冠状缝融合。统计分析显示，标准超声检查与直接检查的诊断准确性之间无显著差异（卡方=0.22，P>0.05）。总之，我们已经表明，在没有其他颅面畸形的情况下，对颅骨缝线进行标准超声检查可能是一种在子宫内诊断单纯性、非综合征性颅缝早闭的可行方法，这种情况在常规产前超声筛查检查中通常会被漏诊。
