Zhang Jinwei,Wu Shuihua,Su Jun,et al.Efficacy of simple posterior parieto-occipital osteotomy and remodeling for children with premature closure of cranial suture plus Chiari malformation type Ⅰ[J].Journal of Clinical Pediatric Surgery,2025,(04):368-371.[doi:10.3760/cma.j.cn101785-202312039-012]
Efficacy of simple posterior parieto-occipital osteotomy and remodeling for children with premature closure of cranial suture plus Chiari malformation type Ⅰ
- Keywords:
- Craniosynostoses; Arnold-Chiari Malformation; Surgical Procedures; Operative; Osteotomy; Parietal Bone; Osteotomy; Occipital Bone; Treatment Outcome; Child
- Abstract:
- Objective To explore the optimal treatment for premature closure of cranial suture plus Chiari malformation type Ⅰ (CM-Ⅰ) and examine the clinical efficacy of simple posterior parieto-occipital osteotomy and remodeling for premature closure of cranial suture plus CM-Ⅰ.Methods From January 2016 to December 2023,the relevant clinical data were retrospectively reviewed for 29 children with premature closure of cranial suture and CM-Ⅰundergoing simple posterior parieto-occipital osteotomy and remodeling.Results There were 11 boys and 18 girls with a mean operative age of 31.5(3-60) month.Basic profiles,diagnoses,imaging studies,intraoperative findings and clinical follow-ups were recorded during a mean follow-up period of 3.4 years (8 months to 4 years).Twenty-seven cases had no Chiari deformity progression or related clinical symptoms after surgery while two cases underwent reduction of greater occipital foramen at a later stage due to a progression of Chiari deformity.Conclusions Simple posterior parieto-occipital osteotomy and remodeling are efficacious for children with premature closure of cranial suture and CM-Ⅰ.It may prevent the progression of Chiari deformity.
References:
[1] 中国医师协会神经外科分会脊柱脊髓专家委员会.儿童Chiari畸形Ⅰ型诊疗专家共识[J].中华神经医学杂志,2023,22(4):325-332.DOI:10.3760/cma.j.cn115354-20230226-00101. Spine and Spinal Cord Expert Committee,Branch of Neurosurgery,Chinese Medical Doctor Association.Expert consensus on diagnosing and treating chiari malformation type Ⅰ in children[J].Chin J Neuromed,2023,22(4):325-332.DOI:10.3760/cma.j.cn115354-20230226-00101.
[2] Langridge B,Phillips E,Choi D.Chiari malformation type 1:a systematic review of natural history and conservative management[J].World Neurosurg,2017,104:213-219.DOI:10.1016/j.wneu.2017.04.082.
[3] Albert GW.Chiari malformation in children[J].Pediatr Clin North Am,2021,68(4):783-792.DOI:10.1016/j.pcl.2021.04.015.
[4] Azoulay-Avinoam S,Bruun R,MacLaine J,et al.An overview of craniosynostosis craniofacial syndromes for combined orthodontic and surgical management[J].Oral Maxillofac Surg Clin North Am,2020,32(2):233-247.DOI:10.1016/j.coms.2020.01.004
[5] Pattisapu JV,Gegg CA,Olavarria G,et al.Craniosynostosis:diagnosis and surgical management[J].Atlas Oral Maxillofac Surg Clin North Am,2010,18(2):77-91.DOI:10.1016/j.cxom.2010.08.002.
[6] 文海韬,顾硕,吴水华.狭颅症的诊疗进展[J].临床小儿外科杂志,2018,17(2):146-149.DOI:10.3969/j.issn.1671-6353.2018.02.014. Wen HT,Gu S,Wu SH.Research advances of diagnosing and treating craniosynostosis[J].DOI:10.3969/j.issn.1671-6353.2018.02.014.
[7] 孙守庆.综合征型颅缝早闭的临床表现及基因诊断[J].临床小儿外科杂志,2017,16(4):409-412.DOI:10.3969/j.issn.1671-6353.2017.04.023. Sun SQ.Clinical manifestations and genetic diagnosis of syniosynostosis with syndromic prescient astosis[J].J Clin Ped Sur,2017,16(4):409-412.DOI:10.3969/j.issn.1671-6353.2017.04.023.
[8] Fearon JA,Ruotolo RA,Kolar JC.Single sutural craniosynostoses:surgical outcomes and long-term growth[J].Plast Reconstr Surg,2009,123(2):635-642.DOI:10.1097/PRS.0b013e318195661a.
[9] Raybaud C,Di Rocco C.Brain malformation in syndromic craniosynostoses,a primary disorder of white matter:a review[J].Childs Nerv Syst,2007,23(12):1379-1388.DOI:10.1007/s00381-007-0474-7.
[10] Leikola J,Koljonen V,Valanne L,et al.The incidence of Chiari malformation in nonsyndromic,single suture craniosynostosis[J].Childs Nerv Syst,2010,26(6):771-774.DOI:10.1007/s00381-009-1044-y.
[11] Cinalli G,Renier D,Sebag G,et al.Chronic tonsillar herniation in Crouzon’s and Apert’s syndromes:the role of premature synostosis of the lambdoid suture[J].J Neurosurg,1995,83(4):575-582.DOI:10.3171/jns.1995.83.4.0575.
[12] Cinalli G,Spennato P,Sainte-Rose C,et al.Chiari malformation in craniosynostosis[J].Childs Nerv Syst,2005,21(10):889-901.DOI:10.1007/s00381-004-1115-z.
[13] Saldino RM,Steinbach HL,Epstein CJ.Familial acrocephalosyndactyly(Pfeiffer syndrome)[J].Am J Roentgenol Radium Ther Nucl Med,1972,116(3):609-622.DOI:10.2214/ajr.116.3.609.
[14] Badve CA,Mallikarjunappa MK,Iyer RS,et al.Craniosynostosis:imaging review and primer on computed tomography[J].Pediatr Radiol,2013,43(6):728-742.DOI:10.1007/s00247-013-2673-6.
[15] Taylor JA,Derderian CA,Bartlett SP,et al.Perioperative morbidity in posterior cranial vault expansion:distraction osteogenesis versus conventional osteotomy[J].Plast Reconstr Surg,2012,129(4):674e-680e.DOI:10.1097/PRS.0b013e3182443164.
[16] Komuro Y,Shimizu A,Shimoji K,et al.Posterior cranial vault distraction osteogenesis with barrel stave osteotomy in the treatment of craniosynostosis[J].Neurol Med Chir (Tokyo),2015,55(8):617-623.DOI:10.2176/nmc.ra.2014-0401.
[17] Scott WW,Fearon JA,Swift DM,et al.Suboccipital decompression during posterior cranial vault remodeling for selected cases of Chiari malformations associated with craniosynostosis[J].J Neurosurg Pediatr,2013,12(2):166-170.DOI:10.3171/2013.4.PEDS12463.
[18] 祝永杰,王刚,何俊平,等.儿童颅缝早闭症合并Chiari畸形的治疗分析[J].中华神经外科杂志,2019,35(12):1236-1239.DOI:10.3760/cma.j.issn.1001-2346.2019.12.010. Zhu YJ,Wang G,He JP,et al.Treatment analysis of craniosynostosis plus Chiari malformation in children[J].Chin J Neurosurg,2019,35(12):1236-1239.DOI:10.3760/cma.j.issn.1001-2346.2019.12.010.
Memo
收稿日期:2023-12-17。
基金项目:湖南省中医药科研课题(C2024022)
通讯作者:吴水华,Email:292454021@qq.com