Volumetric Analysis of Anterior Versus Posterior Cranial Vault Expansion in Patients With Syndromic Craniosynostosis
Volumetric Analysis of Anterior Versus Posterior Cranial Vault Expansion in Patients With Syndromic Craniosynostosis
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DOI：
10.1097/scs.0b013e318240ff49
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发表时间：
2012-03-01
影响因子：
0.9
通讯作者：
Havlik, Robert J.
中科院分区：
文献类型：
--
作者：
Choi, Matthew;Flores, Roberto L.;Havlik, Robert J.
背景：综合征性颅缝早闭与颅内压升高的高发生率相关。最常见的治疗范例是在婴儿期进行前颅穹重建，随后可能进行后颅穹扩张和中面部前移。然而，最近，后颅顶扩张被提倡作为治疗的第一步。我们试图量化这些患者的前颅顶手术和后颅穹手术的体积变化。材料和方法：我们回顾了 2002 年至 2009 年在我们科室接受治疗的综合征性短头颅缝早闭患者，并使用现有的术前细切计算机断层扫描。使用计算机软件（Analyze；明尼苏达州罗切斯特市梅奥诊所）和计算机断层扫描数据，资深作者模拟了前颅骨和后颅骨的扩张。通过分离部分的一系列平移进展来模拟扩张。比较每个模拟程序的体积数据。结果：13 名患者接受了模拟颅穹重建。向前推进 2、10 和 20 毫米时，颅内容量平均增加分别为 1.8%、8.8% 和 17.7%，而向后推进分别达到 2.4%、11.9% 和 23.9%。平均而言，在同等推进程度下，后颅顶重建比前颅骨重建产生的相对扩张多 35%（P < 0.001）。在所有模拟中，后颅穹重建比前颅重建产生更大的颅内体积变化。结论：该模拟表明，在综合征性短头颅缝早闭中，与同等程度的前颅穹推进相比，后颅穹推进可实现约 35% 的颅内体积扩张。这可能有助于指导颅缝早闭症患者的治疗顺序决策。
Background: Syndromic craniosynostosis is associated with a high incidence of elevated intracranial pressure. The most common treatment paradigm is to perform anterior cranial vault reconstruction in infancy followed later by possible expansion of the posterior cranial vault and midface advancement. Recently, however, posterior cranial vault expansion has been advocated as an initial step in treatment. We sought to quantify volumetric changes with anterior versus posterior cranial vault surgery in these patients.Materials and Methods: We reviewed patients with syndromic brachycephalic craniosynostosis treated in our unit from 2002 to 2009 with existing preoperative fine-cut computed tomographic scans. Using computer software (Analyze; Mayo Clinic, Rochester, MN) and computed tomographic data, the senior author simulated both anterior and posterior cranial vault expansions. Expansion was simulated with a series of translational advancements of the separated segments. Volumetric data were compared for each simulated procedure.Results: Thirteen patients underwent simulated cranial vault reconstructions. At 2, 10, and 20 mm of anterior advancement, the mean increase in intracranial volume was 1.8%, 8.8%, and 17.7%, respectively, whereas posterior advancements achieved 2.4%, 11.9%, and 23.9%, respectively. On average, posterior cranial vault reconstruction created 35% more relative expansion than anterior expansion at equivalent degrees of advancement (P < 0.001). In all simulations, posterior cranial vault reconstruction created greater intracranial volume changes than anterior reconstructions.Conclusions: This simulation demonstrates that, in syndromic brachycephalic craniosynostosis, posterior cranial vault advancement achieves approximately 35% greater intracranial volume expansion compared with equivalent degrees of anterior cranial vault advancement. This may help guide decisions in treatment sequencing of patients with syndromic craniosynostosis.