Pi craniectomy combined with orthopedic helmet for treatment of infant sagittal synostosis
10.3760/cma.j.cn114453-20211228-00486
- VernacularTitle:π形截骨术联合矫形头盔治疗婴儿矢状缝早闭
- Author:
Di ZHANG
1
;
Ming GE
;
Dapeng LI
;
Junling WANG
Author Information
1. 国家儿童医学中心 首都医科大学附属北京儿童医院神经外科，北京 100045
- Keywords:
Craniosynostoses;
Sagittal synostosis;
Craniectomy;
Pi craniectomy;
Orthopedic fixation devices
- From:
Chinese Journal of Plastic Surgery
2023;39(1):47-53
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of pi craniectomy combined with orthopedic helmet on sagittal synostosis in infants.Methods:Clinical data of patients with sagittal synostosis treated in the Department of Pediatric Neurosurgery, Beijing Children’s Hospital Affiliated to Capital Medical University from May 2020 to March 2021 were retrospectively analyzed. First treatment was pi craniectomy. A bone strip about 1.5 cm wide was transversely cut from the place about 1.0 cm behind the coronal suture, and its left and right sides went respectively up to the left and right temporoparietal suture and across the sagittal sinus. From the place about 1.5 cm beside the closed sagittal suture, an arc-shaped bone strip was cut paralleling to the sagittal and lambdoidal sutures to the temporoparietal suture. The bone strip was about 2.0 cm wide parallel to the sagittal suture and 1.0 cm wide parallel to the lambdoidal suture. Subsequently, the left and right sides were symmetrically cut with the bone strips shaped as π. Then, 1-2 weeks after operation, the orthopedic helmet was used 20-22 hours a day for 6-10 months. Regular follow-up after surgery, cranial morphology was observed, transverse diameter and anteroposterior diameter of skull were measured, cranial index (CI) and cranial volume were calculated. CI was the ratio of transverse diameter to anteroposterior diameter of skull. CI<0.75 was unsatisfactory, and CI 0.75-0.90 was satisfactory.Results:A total of 4 patients with sagittal synostosis were included in this study, all males, 5 to 11 months old. Preoperative CI was 0.69-0.73, cranial volume 576.7-853.2 ml. All the patients were operated safely. The duration of operation was 2.13-2.28 h, and the amount of blood loss was 30-100 ml. Meanwhile, postoperative hospital stay ranged from 7 to 10 days. After operation, the patients showed subcutaneous swelling of the parietal and occipital areas (self-healing after 7-10 days) and fever. The temperature returned to normal within 5 days. None of the patients presented any neurological abnormalities, cerebrospinal fluid leakage and epidural hematoma caused by meningitis, and dural damage. The postoperative follow-up was 6 to 7 months. According to the results, it indicated that the cranial shape of all the infants was improved. Postoperative CI was 0.76-0.80. The cranial width-length ratio tended to be normal. Postoperative cranial volume was 757.3-1 261.4 ml, and the cranial cavity volume increased significantly.Conclusion:Pi craniectomy combined with orthopedic helmet assisted treatment of infant with sagittal synostosis has many advantages. It has short operation time, less intraoperative bleeding and less postoperative complications. It can significantly improve the appearance of the scaphoid head, make the ratio of skull width to length normal, and dynamically expand the volume of the cranial cavity.
