The volumetric change of cranial cavity in the patients with craniosynostosis after fronto-orbital advancement / 中华整形外科杂志

Objective@#To assess the surgical outcome of fronto-orbital advancement (FOA)in the patients with craniosynostosis by quantitative analysis of the cranial volume using the three-dimensional digital technology.@*Methods@#From January 2010 to February 2016, 10 cases of craniosynostosis were included in the study. The average age of patients was 3.2 years (1 year old to 6.5 years old). All patients underwent modified FOA.Based on the uncompressed digital imaging and communications in medicine (DICOM) data of 3D cranial CT scan, the intracranial volume was measured by Proplan CMF 1.4.The average follow-up time was 23.6 months. We quantitatively analysed brain volume in ten patients with craniosynostosis, comparing with the normal data of age- and sex-matched healthy controls. Paired t tests were performed to compare mean value of the variables.@*Results@#The volume of intracranial cavity was(1 117.39 ± 105.83) ml before surgery and the preoperative volume of intracranial cavity in the control group was (1 251.37 ± 114.35) ml. The difference between the preoperative group and the preoperative control group was statistically significant(P=0.00030). The volume of intracranial cavity was (1 260.84 ± 122.08) ml after surgery. The volume was increased significantly after surgery(P=0.00002). There was no significant difference between the postoperative group and the preoperative control group(P=0.60000). The volume of intracranial cavity was (1 368.65 ± 94) ml at least one year follow-up and the cranial volume of the control group was (1 321.96 ± 80.21) ml. There was no statistically significant difference between the two groups(P=0.07000). There were statistically significant differences between the cranial volume at two weeks after operation and that of one year follow-up (P=0.00300). This result showed that the cranial vault and brain of patients grew and developed normally after FOA surgery.@*Conclusions@#Preoperative cerebral volume in the patients with craniosynostosis was lower than normal. The cranial volume has been effectively expanded and basically reached the normal level after fronto-orbital advancement. Especially, the intracranial volume maintained normal during follow-up.

Postoperative change of skull base of craniosynostoses treated by frontorbital advancement by using 3-D digital technique / 中华医学美学美容杂志

Objective To investigate the deformity of cranial base in patients with craniosynostosis and to evaluate the effect of modified fronto-orbital advancement (FOA) for craniosynostosis using three-dimensional digital technology.Methods From January 2010 to December 2016,10 cases of craniosynostosis were included in the study.All patients underwent modified FOA,we quantitatively analysed the pre-operative deformity and the surgical outcome of FOA performed in ten patients with craniosynostosis.The measurements of skull base were performed based on 3D computed tomography (CT) scan.We assessed the symmetry of skull base and the deflection of anterior cranial fossa.Results The mean patients' age at FOAs was 3.2 years.A significant asymmetry of skull base was found in all patients.The growth of anterior and middle fossae was restricted.On the follow-up CT images 23.6 months after surgery,there was prominent change (P＜0.05) between the two hemibases (CSO(-)ratio) and between the lengths and angles of anterior and middle cranial hemi-fossae (CX,CSX(-),XSM(-) ratio).Anterior cranial vault asymmetry index obviously decreased from 12.4％ to 1.05％ before surgery (P＜0.05).In addition,anterior cranial vault deflection angle proved to also be less after surgical correction (20.33°±9.19° versus 13.13°±5.28°,P＜0.05).Conclusions The asymmetry of skull base can be presented by intracranial view at over 1 year of age.FOA can correct the skeletal malformation of frontotemporal region and the asymmetry of skull base is improved after surgical treatment.

Physiological Changes and Clinical Implications of Syndromic Craniosynostosis

Syndromic craniosynostosis has severe cranial stenosis and deformity, combined with hypoplastic maxillary bone and other developmental skeletal lesions. Among these various lesions, upper air way obstruction by hypoplastic maxillary bone could be the first life-threatening condition after birth. Aggressive cranial vault expansion for severely deformed cranial vaults due to multiple synostoses is necessary even in infancy, to normalize the intracranial pressure. Fronto-orbital advancement (FOA) is recommended for patients with hypoplastic anterior part of cranium induced by bicoronal and/or metopic synostoses, and posterior cranial vault expansion is recommended for those with flattening of the posterior part of the cranium by lambdoid synostosis. Although sufficient spontaneous reshaping of the cranium can be expected by expansive cranioplasty, keeping the cranial bone flap expanded sufficiently is often difficult when the initial expansion is performed during infancy. So far distraction osteogenesis (DO) is the only method to make it possible and to provide low rates of re-expansion of the cranial vault. DO is quite beneficial for both FOA and posterior cranial vault expansion, compared with the conventional methods. Associated hydrocephalus and chronic tonsillar herniation due to lambdoid synostosis can be surgically treatable. Abnormal venous drainages from the intracranial space and air way obstruction should be always considered at any surgical procedures. Neurosurgeons have to know well about the managements not only of the deformed cranial vault and the associated brain lesions but also of other multiple skeletal lesions associated with syndromic craniosynostosis, to improve treatment outcome.

Modification of Le Fort III Osteotomy and Fronto-orbital Advancement for the Correction of Crouzon's Disease

In 1912, Crouzon reported one of craniofacial dysostosis, which was inherited as an autosomal dominant trait and characterized by craniosynostosis, midface hypoplasia, and exorbitism. In 1950, the first midface advancement was performed by means of a total facial osteotomy by Sir Harold Gillies. In 1967, Tessier accomplished complete craniofacial dysjunction by performing Le Fort III-Tessier I osteotomy on the basis of Le Fort III fracture and laid the foundation for modern craniofacial surgery. Variable combinations of the surgeries and osteotomies are performed considering functional disabilities as well as patient's age, general condition, and aesthetic problems. The nineteen-year-old female patient complained of frog-like face and showed severe exorbitism and midface hypoplasia, while the occlusion, being relatively normal. We applied modified Le Fort III osteotomy and fronto- orbital advancement. Over the follow-up period of six months, her previous normal occlusion was preserved and the exorbitism and midface deformity largely improved aesthetically.