Maugans T A, McComb J G, Levy M L
Division of Neurosurgery, Children's Hospital, Los Angeles, Calif, USA.
Pediatr Neurosurg. 1997 Sep;27(3):137-48. doi: 10.1159/000121241.
Although surgical treatment of sagittal synostosis has become normative, the procedure of choice is still debated. This retrospective analysis, during a 10-year period (1986-1995) at Children's Hospital Los Angeles, compares the more conservative strip craniectomy (SC) procedure with a more extensive occipital reduction-biparietal widening calvarial vault remodeling (CVR) technique for the management of sagittal synostosis. SC was performed in 72 patients (61%) and CVR in 46 (39%). Patients undergoing CVR were older (mean 5.3 vs. 3.0 months, p < 0.01), the procedure time longer (mean 126 min vs. 72 min, p < 0.01), intraoperative blood loss greater (mean 243 vs. 54 cm3, p < 0.01), and the frequency of intraoperative blood transfusion increased (100 vs. 38%, p < 0.01; mean volume 357 vs. 51 cm3, p < 0.01) compared to patients undergoing SC. No significant intraoperative complications occurred in either group. The total time of hospitalization was similar (mean 4.4 vs. 3.8 days, p = 0.02). No neurological, hematological, or transfusion-related complications or deaths were encountered in either group. Cosmetic outcomes were significantly better in the CVR group with 79% rated as excellent compared to 41% in the SC group (p < 0.01). Fifty-nine percent of the SC patients manifested bony defects at last follow-up visit. Two SC patients required reoperation for poor cosmetic outcomes; CVR was successfully employed in both cases. These findings demonstrate that CVR is superior to SC in providing immediate and lasting correction of calvarial deformities secondary to sagittal synostosis. The optimal age at time of surgery is <6 months; however, CVR can be utilized throughout infancy, while SC becomes progressively less effective after 6 months of age. No significant complications were observed in either group, despite the increased operative manipulation and greater incidence of blood transfusion in the CVR patients.
尽管矢状缝早闭的手术治疗已成为规范，但首选手术方法仍存在争议。本回顾性分析对洛杉矶儿童医院10年期间（1986 - 1995年）采用更为保守的条带颅骨切除术（SC）与更为广泛的枕部减压 - 双侧顶骨扩宽颅骨穹窿重塑术（CVR）治疗矢状缝早闭的情况进行了比较。72例患者（61%）接受了SC手术，46例（39%）接受了CVR手术。接受CVR手术的患者年龄更大（平均5.3个月对3.0个月，p < 0.01），手术时间更长（平均126分钟对72分钟，p < 0.01），术中失血量更多（平均243对54立方厘米，p < 0.01），与接受SC手术的患者相比，术中输血频率增加（100%对38%，p < 0.01；平均输血量357对51立方厘米，p < 0.01）。两组均未发生明显的术中并发症。总住院时间相似（平均4.4天对3.8天，p = 0.02）。两组均未出现神经、血液学或输血相关并发症或死亡情况。CVR组的美容效果明显更好，79%被评为优秀，而SC组为41%（p < 0.01）。59%的SC患者在最后一次随访时出现骨缺损。2例SC患者因美容效果不佳需要再次手术；两例均成功采用了CVR手术。这些发现表明，在对矢状缝早闭继发的颅骨畸形进行即时和持久矫正方面，CVR优于SC。手术的最佳年龄是<6个月；然而，CVR可在整个婴儿期使用，而SC在6个月龄后效果逐渐变差。尽管CVR患者的手术操作增加且输血发生率更高，但两组均未观察到明显并发症。
