Posterior skull surgery in craniosynostosis
Posterior skull surgery in craniosynostosis
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DOI：
10.1007/bf00366158
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发表时间：
1996-11-01
影响因子：
1.4
通讯作者：
Wake, MJC
中科院分区：
文献类型：
--
作者：
Sgouros, S;Goldin, JH;Wake, MJC
1984年，两名患有不寻常的“三叶草”型颅骨畸形的婴儿通过后路颅骨松解手术治疗，显著改善了他们的整体颅骨形状，不需要进一步的手术干预。这将我们的注意力集中在后颅骨及其在颅缝闭锁中的作用上。在多缝合线颅缝闭合和颅面综合征的病例中，颅内压严重升高是常见的，需要早期手术。在6个月前进行这种手术的问题之一是复发性颅缝闭锁需要以后再次手术。1978年至1994年期间接受治疗的275例患者中有15例（5%）出现这种情况。自1986年以来，在颅内压明显升高的情况下，我们的策略是进行初始后颅骨释放或减压。这就减轻了成长中的大脑对眼眶的压力，允许我们推迟前额眼眶的发育，直到12个月或更晚。采用这种方法治疗的3例患者完全避免了前路手术，另外9例患者因复发性前路畸形无需再次手术。这一政策的例外是存在严重的驱魔行为，对视力构成威胁。在这种情况下，早期额眶前进是必需的，随后进行额外的后颅骨松解可能会有所帮助。争论仍在继续，特别是在单侧小羔羊关节滑脱的处理上。最近体位后斜头畸形的增加，可能与新生儿的仰卧位护理有关，强调需要区分固定畸形（可能需要手术矫正）和枕部体位塑形（可自行改善）。本文报告了我们对22例接受后颅骨手术治疗的患者的经验，无论是单独手术还是作为附加手术，我们认为后颅骨手术在颅缝闭锁的治疗中具有明确的作用。
In 1984, two young infants with unusual ''clover-leaf'' patterns of skull deformity were treated by posterior skull-releasing surgery that dramatically improved their overall skull shape, to the extent that further operative intervention was not required. This focused our attention on the posterior skull and its role in craniosynostosis. In cases of multi-suture craniosynostosis and craniofacial syndromes severely raised intracranial pressure is frequent, demanding early surgery. One of the problems identified with such surgery undertaken before 6 months of age is recurrent craniosynostosis needing later re-operation. This occurred in 15 (5%) of 275 patients treated between 1978 and 1994. Since 1986, in the presence of significantly raised intracranial pressure it has been our policy to do an initial posterior skull release or decompression. This takes the pressure of the growing brain away from the orbits, allowing us to defer fronto-orbital advancement until the age of 12 months or later. Three patients managed in this way completely avoided anterior surgery, while in another 9 patients re-operation for recurrent anterior deformity has not been required. The exception to this policy has been the presence of severe exorbitism posing a threat to vision. Under these circumstances early fronto-orbital advancement is mandatory, and an additional posterior skull release may be helpful later. Debate continues especially on the management of unilateral lambdoid synostosis. The recent increase in positional posterior plagiocephaly, possibly related to supine nursing of newborns, has emphasised the need to differentiate between a fixed deformity, which might require surgical correction, and positional moulding of the occiput, which improves spontaneously. This paper reports our experience with 22 patients treated by posterior skull surgery, either alone or as an additional procedure, which we believe has a definitive role in the management of craniosynostosis.