Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

被引：17

作者：

van Veelen, Marie-Lise C. ^{[1
]}

Mihajlovic, Dalibor ^{[1
]}

Dammers, Ruben ^{[1
]}

Lingsma, Hester ^{[2
]}

van Adrichem, Leon N. A. ^{[3
]}

Mathijssen, Irene M. J. ^{[3
]}

机构：

[1] Erasmus Univ, Med Ctr Rotterdam, Dept Neurosurg, NL-3000 CB Rotterdam, Netherlands

[2] Erasmus Univ, Med Ctr Rotterdam, Dept Publ Hlth, NL-3000 CB Rotterdam, Netherlands

[3] Erasmus Univ, Med Ctr Rotterdam, Dept Plast & Reconstruct Surg & Hand Surg, NL-3000 CB Rotterdam, Netherlands

来源：

JOURNAL OF NEUROSURGERY-PEDIATRICS | 2015年 / 16卷 / 01期

关键词：

sagittal synostosis; surgery; outcome; craniofacial; EARLY SURGICAL-CORRECTION; LONG-TERM GROWTH; STRIP CRANIECTOMY; CLINICAL ARTICLE; INTRACRANIAL-PRESSURE; SUTURE SYNOSTOSIS; MELBOURNE METHOD; FOLLOW-UP; CRANIOSYNOSTOSIS; MANAGEMENT;

D O I：

10.3171/2014.12.PEDS14260

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

OBJECT Various techniques to correct sagittal synostosis have been described. The authors of this study assess the results of 2 techniques for late complete cranial remodeling and test the hypothesis that adding a widening bridge would, improve outcome. METHODS In this retrospective study, the authors evaluated patients with nonsyndromic sagittal synostosis-those who underwent frontobiparietal remodeling (FBR) and those who underwent modified FBR (MFBR) involving the introduction of a bony bridge to increase the width of the skull. Outcomes for both groups are described in terms of the aesthetic results assessed on photographs and any changes in the cranial index (CI) and head circumference over time, the presence of papilledema, and complaints of headache. The effect of the surgical technique on CI and head circumference over time was assessed using linear regression analysis, with adjustment for preoperative Cl and head circumference. RESULTS Sixty-nine patient with isolated sagittal synostosis were included in this study: 35 underwent MFBR and 34 underwent the original technique of FBR. The mean follow-up period was 7 years. In the 1st year after surgery, mean Cl improved by 9% in the FBR group and by 12% in the MFBR group. One year after surgery, Cl in the MFBR group was on average 4.7% higher than that in the FBR group (p < 0.001). During follow-up, CI decreased in both groups; however, at all time points Cl was significantly higher in the MFBR group than in the FBR group. The impact of surgical technique on CI was less important than the impact of preoperative Cl (R-2 = 0.26 vs 0.54), and this applied at all time points during follow-up. Head circumference declined during follow-up in both groups. It was influenced by preoperative head circumference, but not by surgical technique. Aesthetic outcome, prevalence of headache (42%), and papilledema (7%) were comparable in both groups. CONCLUSIONS Adding a widening bridge to late complete remodeling significantly improved CI and helped to prevent Cl from decreasing in the long term. This addition did not affect the head circumference growth curve. Despite a mean head circumference remaining at +1 SD, patients continued to develop papilledema postoperatively (7%).

引用

页码：86 / 93

页数：8