Wang Yanzhao,Zhang Runlu,Yang Chen,et al.Surgical management of pediatric calvarial lesions involving venous sinuses: A single-center experience[J].Journal of Clinical Pediatric Surgery,2025,(06):565-569.[doi:10.3760/cma.j.cn101785-202502031-011]
儿童静脉窦相关颅骨肿物手术治疗的单中心经验分析
- Title:
- Surgical management of pediatric calvarial lesions involving venous sinuses: A single-center experience
- Keywords:
- Child; Cranium; Venous Sinus; Cranioplasty; Poly-ether-ether-ketone
- 摘要:
- 目的 探讨儿童静脉窦相关颅骨肿物的手术切除与一期颅骨成形术治疗要点及临床疗效。方法 本研究为回顾性研究,收集2019年1月至2024年1月山东大学齐鲁医院神经外科收治的儿童静脉窦相关颅骨肿物行手术切除并一期行颅骨修补术的9例患儿临床资料,患儿术前均行薄层颅脑CT及MRI检查,通过IMPAX 软件模拟肿物切除范围,定制人工颅骨修补材料,术中切除肿物后一期行颅骨成形术。总结分析患儿临床表现、治疗及预后。结果 9例患儿年龄4~13岁,术后病理检查证实为郎格罕细胞组织细胞增生症5例、骨纤维结构不良1例、非霍奇金B淋巴母细胞性淋巴瘤1例、颅骨筋膜炎1例、骨瘤1例。7例为全切病变,2例为大部切除。1例淋巴瘤患儿后期接受放疗及化疗,1例郎格罕细胞组织细胞增生症患儿后期接受化疗,其余患儿术后均采取单纯随诊策略。9例均用术前定制的人工颅骨聚醚醚酮材料修补颅骨缺损,无一例发生静脉窦损伤、脑损伤、术后血肿、感染、切口愈合不良等并发症,仅1例出现皮下积液。随访时间1~6年,无一例出现复发或远期并发症。结论 在确保手术安全的前提下最大化切除病灶及采用定制人工颅骨行一期颅骨成形术,是儿童静脉窦相关颅骨肿物的有效手术策略。
- Abstract:
- Objective To evaluate the key surgical considerations and clinical efficacy of tumor resection combined with one-stage cranioplasty for calvarial lesions involving the dural venous sinuses in children. Methods In this retrospective study,the clinical data of nine children who underwent resection of calvarial lesions involving the dural venous sinuses followed by immediate cranioplasty in the Department of Neurosurgery,Qili Hospital of Shandong University,between January 2019 and January 2024 were reviewed.Pre-operative thin-slice cranial CT and MRI were performed for every patient;lesion excision margins were simulated with IMPAX software,and patient-specific artificial cranial implants were fabricated accordingly.After tumor excision,one-stage cranioplasty was completed intra-operatively.Clinical presentation,management,and outcomes were summarized and analyzed. Results The nine patients,aged 4 to 13 years,had postoperative histopathology confirming Langerhans cell histiocytosis (LCH) in 5 cases,fibrous dysplasia in 1,B-lymphoblastic non-Hodgkin lymphoma in 1,cranial fasciitis in 1,and osteoma in 1.Gross-total resection was achieved in 7 cases and subtotal resection in 2.The lymphoma patient subsequently received radiotherapy and chemotherapy,and one child with Langerhans cell histiocytosis received postoperative chemotherapy;the remaining patients were managed with follow-up alone.All skull defects were reconstructed with pre-fabricated patient-specific poly-ether-ether-ketone implants.No venous-sinus injury,brain injury,postoperative hematoma,infection,or wound-healing complications occurred;only one child developed a subgaleal fluid collection.During 1 to 6 years of follow-up,no recurrences or late complications were observed. Conclusions Maximal safe resection combined with immediate one-stage cranioplasty using customized artificial implants is an effective surgical strategy for calvarial lesions abutting dural venous sinuses in children.
参考文献/References:
[1] Wei M,Jiang WB,Wang R,et al.Langerhans cell histiocytosis of the skull in 23 children[J].Eur J Med Res,2024,29(1):136.DOI:10.1186/s40001-024-01727-5.
[2] Martin E,Senders JT,Ter Wengel PV,et al.Treatment and survival of osteosarcoma and Ewing sarcoma of the skull:a SEER database analysis[J].Acta Neurochir (Wien),2019,161(2):317-325.DOI:10.1007/s00701-018-3754-y.
[3] Wagner RD,Wang EK,Lloyd MS,et al.Cranial fasciitis:a systematic review and diagnostic approach to a pediatric scalp mass[J].J Craniofac Surg,2016,27(1):e65-e71.DOI:10.1097/SCS.0000000000002230.
[4] Langlie JA,Hullfish H,Jabori SK,et al.Diagnosis and management of craniofacial osteomas[J].J Craniofac Surg,2023,34(5):1515-1521.DOI:10.1097/SCS.0000000000009395.
[5] Dalle Carbonare M,Manisali M.Surgical management of syndromic versus non-syndromic craniofacial fibrous dysplasia:a systematic review and meta-analysis[J].Br J Oral Maxillofac Surg,2022,60(9):1166-1175.DOI:10.1016/j.bjoms.2022.06.002.
[6] Villavisanis DF,Schmidt RJ,Napoli JA.Pediatric maxillary giant cell tumors:surgical management by transoral and endoscopic transnasal enucleation and curettage[J].J Craniofac Surg,2022,33(7):e747-e750.DOI:10.1097/SCS.0000000000008689.
[7] Sveikata L,Vasung L,El Rahal A,et al.Syndrome of the trephined:clinical spectrum,risk factors,and impact of cranioplasty on neurologic recovery in a prospective cohort[J].Neurosurg Rev,2022,45(2):1431-1443.DOI:10.1007/s10143-021-01655-6.
[8] Goyal G,Tazi A,Go RS,et al.International expert consensus recommendations for the diagnosis and treatment of Langerhans cell histiocytosis in adults[J].Blood,2022,139(17):2601-2621.DOI:10.1182/blood.2021014343.
[9] 尹国阳,刘翠翠,肖以磊,等.颅骨朗格汉斯组织细胞增生症的临床特点及诊疗体会[J].中华神经医学杂志,2021,20(5):495-500.DOI:10.3760/cma.j.cn115354-20200901-00701. Yin GY,Liu CC,Xiao YL,et al.Clinical characteristics and diagnosis and treatment experiences of Langerhans cell histocytosis in skull[J].Chin J Neuromedicine,2021,20(5):495-500.DOI:10.3760/cma.j.cn115354-20200901-00701.
[10] D?ring K,Ivanyi P,Lanfermann H,et al.Langerhans cell histiocytosis involving the temporal bone with destruction and subsequent reossification of the bony labyrinth boundaries[J].Rofo,2024,196(10):1063-1067.DOI:10.1055/a-2254-5536.
[11] 李春旺,尹一伟,蔡齐芳,等.儿童朗格汉斯细胞组织细胞增生症累及中枢神经系统及颅面骨的影像学特征分析[J].临床小儿外科杂志,2023,22(8):768-772.DOI:10.3760/cma.j.cn101785-202305023-013. Li CW,Yin YW,Cai QF,et al.Imaging features of Langerhans cell histiocytosis involving central nervous system and craniofacial bone in children[J].DOI:10.3760/cma.j.cn101785-202305023-013.
[12] Ishida K,Sakamoto Y,Kosugi K,et al.The long-term natural history of fibrous dysplasia[J].J Craniofac Surg,2024,35(6):e540-e541.DOI:10.1097/scs.0000000000010245.
[13] Gharibi Loron A,Tunaboylu MF,Bite U.Technologically comprehensive reconstruction of fronto-orbito-sphenoidal craniofacial fibrous dysplasia[J].J Craniofac Surg,2025,36(1):58-60.DOI:10.1097/scs.0000000000010514.
[14] Frassanito P,Beez T.Cranial repair in children:techniques,materials,and peculiar issues[J].Adv Tech Stand Neurosurg,2024,49:307-326.DOI:10.1007/978-3-031-42398-7_14.
相似文献/References:
[1]杜朝峻,丁力,胡英超,等.手术治疗婴幼儿法洛四联症83例[J].临床小儿外科杂志,2010,9(06):413.
DU Chao jun,DING Li,HU Ying chao,et al.Surgical treatment of Tetralogy of Fallot in infancy: Experiences of 83 cases.[J].Journal of Clinical Pediatric Surgery,2010,9(06):413.
[2]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[3]王勇,汤绍涛,毛永忠,等.腔镜下手术治疗小儿膈肌疾病31例[J].临床小儿外科杂志,2010,9(06):441.
[4]欧阳帆,张治明,曾宾,等.七氟醚复合髂腹股沟-髂腹下神经阻滞用于小儿腹股沟手术[J].临床小儿外科杂志,2010,9(06):466.
[5]徐华,赵陶丽.瑞芬太尼对小儿等离子刀扁桃体腺样体切除术应激反应的影响[J].临床小儿外科杂志,2010,9(06):468.
[6]周辉霞孙宁马立飞孟浩谢华伟申州陶天周晓光黄澄如李宏召张旭.腹腔镜下重复肾半肾切除术手术路径探讨[J].临床小儿外科杂志,2011,10(01):0.
ZHOU Hui xia,SU Ning,MA Li fei,et al.Which laparoscopic surgery approach is better for a nonfunctioning moiety in a duplex kidney in infants and children[J].Journal of Clinical Pediatric Surgery,2011,10(06):0.
[7]蒋欣李箭刘利君彭明惺唐学阳.儿童单纯性膝关节骨软骨骨折的关节镜治疗[J].临床小儿外科杂志,2011,10(01):0.
JIANG Xin,LI Jian,LIU Li jun,et al.Arthroscopic therapy of osteochondral fractures of the Knee in children.[J].Journal of Clinical Pediatric Surgery,2011,10(06):0.
[8]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(06):0.
[9]寿铁军李勇马能强龚晟.腹腔镜手术治疗小儿腹股沟斜疝1582例[J].临床小儿外科杂志,2011,10(01):0.
[10]吴臻斐陈聪德林进汉刘平李仲荣陈肖鸣.小儿急性肠套叠肠坏死相关因素分析[J].临床小儿外科杂志,2011,10(01):0.
[11]李春旺,尹一伟,蔡齐芳,等.儿童朗格汉斯细胞组织细胞增生症累及中枢神经系统及颅面骨的影像学特征分析[J].临床小儿外科杂志,2023,22(08):768.[doi:10.3760/cma.j.cn101785-202305023-013]
Li Chunwang,Yin Yiwei,Cai Qifang,et al.Imaging features of Langerhans cell histiocytosis involving central nervous system and craniofacial bone in children[J].Journal of Clinical Pediatric Surgery,2023,22(06):768.[doi:10.3760/cma.j.cn101785-202305023-013]
备注/Memo
收稿日期:2025-2-16。
基金项目:山东大学课题(6010124088);齐鲁卫生与健康杰出青年人才(202101)
通讯作者:王传伟,Email:wcw_qlhospital@163.com;宫杰,Email:gongjie@sdu.edu.cn