Li Sen,Zhan Qijia,Xiao Bo,et al.Improvements of frontal lobe volume and social emotions on metopic synostosis with frontal-orbital advancement[J].Journal of Clinical Pediatric Surgery,2024,(02):119-124.[doi:10.3760/cma.j.cn101785-202311041-004]
额眶前移手术对额缝早闭患儿额叶容量及社会情绪改善的效果评价
- Title:
- Improvements of frontal lobe volume and social emotions on metopic synostosis with frontal-orbital advancement
- Keywords:
- Craniosynostoses; Metopic Synostosis; Surgical Procedures; Operative; Frontal-orbital Advancement; Treatment Outcome; Social-emotional Assessment; Child
- 摘要:
- 目的 探讨额眶前移手术改善额缝早闭患儿额叶容量和社会情绪的效果。方法 回顾性分析自2017年1月至2021年10月在上海市儿童医院诊断并接受额眶前移手术治疗的15例额缝早闭患儿临床资料。分别于术前、术后1年及末次随访［术后(52±19)个月］时,采用头颅MRI检查及Slicer 5.4.0进行前额体积、脑体积和额角的计算,同期采用社会情绪调查量表对患儿社会情绪进行评估。结果 15例均行额眶前移手术。术前额叶体积为106.58(103.38,112.35)cm3,脑体积为528.65(496.57,563.36)cm3,额角为91.3(89.6,93.3)°,额叶/脑比例为20(20,20)%;术后1年额叶体积为149.64(145.64,168.85)cm3,脑体积为623.71(587.76,651.87)cm3,额角为109.5(106.4,114.6)°,额叶/脑比例为24(20,30)%;末次随访时,额叶体积为217.18(208.44,238.42)cm3,脑体积为870.62(786.21,961.88)cm3,额角为116.4(113.4,120.7)°,额叶/脑比例25(20,30)%;上述指标于术后1年及末次随访显示均较术前明显改善(P＜0.05)。术后1年额叶增长比例32(30,30)%,显著高于脑增长比例15(10,20)%,差异有统计学意义(P＜0.05);末次随访时额叶增长比例51(50,50)%,脑增长比例39(30,40)%,差异有统计学意义(P＜0.05)。患儿术前社会情绪得分为85(85,95)分,显著高于正常界值(50分);术后1年随访时,社会情绪显著下降至50(50,55)分,基本接近正常界值;末次随访时,社会情绪得分为35(30,40)分,15例患儿均低于界值,达到正常水平,较术前显著改善(P＜0.05)。结论 额眶前移术可显著增加额缝早闭患儿额叶容量,改善前额畸形,同时有效改善不良社会情绪。
- Abstract:
- Objective To explore the therapeutic efficacy of frontal orbital advancement on improving social-emotional abnormalities and frontal lobe volume in children with metopic synostosis (MS).Methods From January 2017 to October 2021,retrospective review was performed for the relevant clinical data of 15 infants of premature closure of frontal suture managed with frontal orbital advancement.At the timepoints of pre-operation,1-year post-operation and during a final postoperative follow-up period of (52±19) month,Social-Emotional Assessment (ASQ:SE) was utilized for assessing social-emotional well-being.And cranial magnetic resonance imaging (MRI) along with 3D Slicer 5.4.0 software was employed for calculating frontal lobe volume,brain volume and frontal angle.Results Frontal orbital advancement was performed.Preoperative measurements of frontal lobe volume were 106.58(103.38,112.35)cm3,brain volume 528.65(496.57,563.36)cm3,frontal angle 91.3(89.6,93.3)?nd frontal lobe/brain volume 20(20,20)%.At 1-year post-operation,frontal lobe volume was 149.64(145.64,168.85)cm3,brain volume 623.71(587.77,651.87)cm3,frontal angle 109.5(106.4,114.6)?nd frontal lobe/brain volume 24(20,30)%.At the final follow-up,frontal lobe volume was 217.18(208.44,238.42)cm3,brain volume 870.62(786.21,961.88)cm3,frontal angle 116.4(113.4,120.7)° and frontal lobe/brain volume 25(20,30)% with statistical significance (P<0.05).At 1-year post-operation,proportion of frontal lobe growth was significant higher than brain growth ［32(30,30)% vs.15(10,20)%,P<0.05］.At the final follow-up,proportion of frontal lobe growth was significant higher than brain growth ［51(50,50)% vs. 39(30,40)%,P<0.05］.Preoperative social-emotional scores of 85(85,95) were significantly higher than normal threshold.However,at 1-year post-operation,social-emotional scores 50(50,55) dropped markedly.At the final follow-up,all social-emotional scores 35(30,40) declined below a threshold and normalized.Conclusions For MS children,frontal orbital advancement may significantly boost frontal volume and effectively improve adverse social-emotional outcomes.
参考文献/References:
[1] Vergnaud E,Vecchione A,Blanot S,et al.Reducing blood losses and transfusion requirements in craniosynostosis surgery:an endless quest?[J].Anesthesiology,2012,116(3):733-734.DOI:10.1097/ALN.0b013e3182449fc8.
[2] van der Meulen J,van der Hulst R,van Adrichem L,et al.The increase of metopic synostosis:a pan-European observation[J].J Craniofac Surg,2009,20(2):283-286.DOI:10.1097/scs.0b013e31818436be.
[3] Weinzweig J,Kirschner RE,Farley A,et al.Metopic synostosis:defining the temporal sequence of normal suture fusion and differentiating it from synostosis on the basis of computed tomography images[J].Plast Reconstr Surg,2003,112(5):1211-1218.DOI:10.1097/01.PRS.0000080729.28749.A3.
[4] Vu HL,Panchal J,Parker EE,et al.The timing of physiologic closure of the metopic suture:a review of 159 patients using reconstructed 3D CT scans of the craniofacial region[J].J Craniofac Surg,2001,12(6):527-532.DOI:10.1097/00001665-200111000-00005.
[5] Engel M,Thiele OC,Mühling J,et al.Trigonocephaly:results after surgical correction of nonsyndromatic isolated metopic suture synostosis in 54 cases[J].J Craniomaxillofac Surg,2012,40(4):347-353.DOI:10.1016/j.jcms.2011.05.010.
[6] Kelleher MO,Murray DJ,McGillivary A,et al.Behavioral,developmental,and educational problems in children with nonsyndromic trigonocephaly[J].J Neurosurg,2006,105(5 Suppl):382-384.DOI:10.3171/ped.2006.105.5.382.
[7] Sidoti EJJr,Marsh JL,Marty-Grames L,et al.Long-term studies of metopic synostosis:frequency of cognitive impairment and behavioral disturbances[J].Plast Reconstr Surg,1996,97(2):276-281.DOI:10.1097/00006534-199602000-00002.
[8] Kapp-Simon KA,Speltz ML,Cunningham ML,et al.Neurodevelopment of children with single suture craniosynostosis:a review[J].Childs Nerv Syst,2007,23(3):269-281.DOI:10.1007/s00381-006-0251-z.
[9] van der Vlugt JJB,van der Meulen JJNM,Creemers HE,et al.Cognitive and behavioral functioning in 82 patients with trigonocephaly[J].Plast Reconstr Surg,2012,130(4):885-893.DOI:10.1097/PRS.0b013e318262f21f.
[10] Almli CR,Rivkin MJ,McKinstry RC.The NIH MRI study of normal brain development (Objective-2):newborns,infants,toddlers,and preschoolers[J].Neuroimage,2007,35(1):308-325.DOI:10.1016/j.neuroimage.2006.08.058.
[11] 卞晓燕,Squires J,卢红梅,等.年龄与发育进程问卷:社会-情绪(第2版)的中国常模及信度研究[J].中国儿童保健杂志,2021,29(1):23-27,51.DOI:10.11852/zgetbjzz2020-1795.Bian XY,Squires J,Lu HM,et al.Study on the norm and the reliability of the second edition of the ages & stages questionnaires:social-emotional with a Chinese national sample[J].Chin J Child Health Care,2021,29(1):23-27,51.DOI:10.11852/zgetbjzz2020-1795.
[12] Peterson M,Warf BC,Schiff SJ.Normative human brain volume growth[J].J Neurosurg Pediatr,2018,21(5):478-485.DOI:10.3171/2017.10.PEDS17141.
[13] Havlik RJ,Azurin DJ,Bartlett SP,et al.Analysis and treatment of severe trigonocephaly[J].Plast Reconstr Surg,1999,103(2):381-390.DOI:10.1097/00006534-199902000-00004.
[14] Beckett JS,Chadha P,Persing JA,et al.Classification of trigonocephaly in metopic synostosis[J].Plast Reconstr Surg,2012,130(3):442e-447e.DOI:10.1097/PRS.0b013e31825dc244.
[15] Ruiz-Correa S,Starr JR,Lin HJ,et al.New severity indices for quantifying single-suture metopic craniosynostosis[J].Neurosurgery,2008,63(2):318-325.DOI:10.1227/01.NEU.0000316417.06500.DA.
[16] Netherway DJ,Abbott AH,Anderson PJ,et al.Intracranial volume in patients with nonsyndromal craniosynostosis[J].J Neurosurg,2005,103(2 Suppl):137-141.DOI:10.3171/ped.2005.103.2.0137.
[17] Freudlsperger C,Steinmacher S,B?chli H,et al.Metopic synostosis:measuring intracranial volume change following fronto-orbital advancement using three-dimensional photogrammetry[J].J Craniomaxillofac Surg,2015,43(5):593-598.DOI:10.1016/j.jcms.2015.02.017.
[18] Maltese G,Tarnow P,Wikberg E,et al.Intracranial volume before and after surgical treatment for isolated metopic synostosis[J].J Craniofac Surg,2014,25(1):262-266.DOI:10.1097/SCS.0000000000000423.
[19] 颜青,何俊平,高喆,等.评价计算机辅助三维重建下额眶重建术治疗额缝早闭症的早期疗效[J].中华小儿外科杂志,2019,40(10):899-904.DOI:10.3760/cma.j.issn.0253-3006.2019.10.007.Yan Q,He JP,Gao Z,et al.Early clinical efficacy of computer-aided three-dimensional frontal orbital reconstruction for pediatric metopic synostosis[J].Chin J Pediatr Surg,2019,40(10):899-904.DOI:10.3760/cma.j.issn.0253-3006.2019.10.007.
[20] 董留建,齐林.改良额眶前移术对颅缝早闭患儿颅脑生长发育的影响[J].现代诊断与治疗,2020,31(21):3433-3435.Dong LJ,Qi L.Effect of modified fronto-orbital advancement on the growth and development of brain in children with premature closure of cranial suture[J].Mod Diagn Treat,2020,31(21):3433-3435.
[21] 吴水华,梁大中.非综合征性颅缝早闭患儿手术后ASQ-3年龄与发育进程问卷评估结果的相关因素分析[J].临床小儿外科杂志,2023,22(8):762-767.DOI:10.3760/cma.j.cn101785-202304003-012.Wu SH,Liang DZ.Analysis of factors related to ASQ-3 age and developmental process assessment questionnaire in children with nonsyndromic craniosynostosis after surgery[J].J Clin Ped Sur,2023,22(8):762-767.DOI:10.3760/cma.j.cn101785-202304003-012.
[22] 蒋文怡,董晨彬,吴颖,等.颅缝早闭婴幼儿手术治疗前后发育筛查结果分析[J].中华小儿外科杂志,2022,43(10):865-868.DOI:10.3760/cma.j.cn421158-20210918-00453.Jiang WY,Dong CB,Wu Y,et al.Developmental screening results of infants with craniosynostosis before and after operations[J].Chin J Pediatr Surg,2022,43(10):865-868.DOI:10.3760/cma.j.cn421158-20210918-00453.
[23] Kapp-Simon KA,Figueroa A,Jocher CA,et al.Longitudinal assessment of mental development in infants with nonsyndromic craniosynostosis with and without cranial release and reconstruction[J].Plast Reconstr Surg,1993,92(5):831-839.DOI:10.1097/00006534-199392050-00008.
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备注/Memo
收稿日期:2023-11-27。
基金项目:上海市科学技术委员会"科技创新行动计划"项目(20Y11905800)
通讯作者:陈欣,Email:chenxin@shchildren.com.cn