Quantitative Analysis of Change in Intracranial Volume After Posterior Cranial Vault Distraction
Quantitative Analysis of Change in Intracranial Volume After Posterior Cranial Vault Distraction
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DOI：
10.1097/scs.0000000000002739
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发表时间：
2016-07-01
影响因子：
0.9
通讯作者：
Arai, Hajime
中科院分区：
文献类型：
--
作者：
Shimizu, Azusa;Komuro, Yuzo;Arai, Hajime
后颅穹窿牵引被认为比额眶前移或前颅穹窿扩张更有效地增加颅内容量，但后颅穹窿牵引后颅内容量的变化仍不清楚。观察了该技术治疗早期颅缝早闭患者的颅内容积变化。2011年至2014年，顺天堂大学医院对7名患者（3名男孩和4名女孩，手术时年龄为5个月至3岁3个月（平均23个月））进行了颅缝早闭后颅穹窿牵引术。对患者特征、牵张长度以及术前和术后计算机断层扫描结果进行了审查。使用三维计算机断层扫描的工作站功能测量颅内总体积，包括幕上间隙和后颅窝。除了2例需要额外手术的患者外，进行了后路牵引，没有严重并发症。牵引长度为22.3 ~ 39 mm（平均31 mm），颅内容积变化为144 ~ 281 mL（平均192 mL），颅内容积扩大率为113%~ 134%（平均121%）。目前对后路牵引后颅内体积变化的定量分析显示，与以前的报告相比，颅内体积增加更大。此外，我们的患者的颅内体积变得接近正常，并在随访期间（最长13个月）保持不变。后颅顶牵引术能有效增加颅容积，可作为颅缝早闭症的首选治疗方法。
Posterior cranial vault distraction is considered to be more effective for increasing intracranial volume than frontoorbital advancement or anterior cranial vault expansion, but the changes in intracranial volumes after posterior cranial vault distraction remain unclear. The changes in intracranial volume were investigated in patients of premature craniosynostosis treated by this technique. Seven patients, 3 boys and 4 girls aged from 5 months to 3 years 3 months (mean 23 months) at operation, with craniosynostosis underwent posterior cranial vault distraction at Juntendo University Hospital from 2011 to 2014. Patient characteristics, length of distraction, and pre- and postoperative computed tomography findings were reviewed. Total intracranial volume, including the supratentorial space and posterior cranial fossa, was measured using the workstation functions on three-dimensional computed tomography scans. Posterior distraction was performed without severe complications except in 2 patients requiring additional surgeries. The distraction length was 22.3 to 39 mm (mean 31 mm), the intracranial volume change was 144 to 281 mL (mean 192 mL), and the enlargement ratio of intracranial volume was 113% to 134% (mean 121%). The present quantitative analysis of intracranial volume change after posterior distraction showed greater increases in intracranial volume compared with previous reports. Furthermore, intracranial volumes in our patients became nearly normal and were maintained for the follow-up period (maximum 13 months). Posterior cranial vault distraction is very effective to increase cranial volume, so may be the first choice of treatment in patients of craniosynostosis.