For citation: Reshchikov D.A., Lopatin A.V., Kholin A.A., Yasonov S.A., Vasiliev I.G., Kugushev A.Yu. Diagnosis and treatment of sagittal craniosynostosis in children over 2 years of age. Head and neck. Russian Journal. 2021;9(1):10–19 (In Russian).
The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.
Isolated sagittal craniosynostosis is the most common form of craniosynostosis. The characteristic appearance of patients, and the rapid development of the intracranial hypertension signs allow to quickly establish a diagnosis and carry out surgical treatment at the optimal time period — the first year of a child’s life. Despite the abundance of information, parents of children with scaphocephaly over 2 years of age often seek help. The peculiarities of the course of the disease at this age, structural changes in the bones of the cranial vault and, associated with this, the peculiarities of surgery make it possible to distinguish such patients as a special group. Objective of the study. Determination of the optimal diagnostic tactics, assessment of the effectiveness of existing surgical techniques for the treatment of isolated sagittal craniosynostosis in children over 2 years of age. Material and methods. For the period from 2015 to 2020, the results of treatment of 36 children with isolated sagittal craniosynostosis at the age from 2 to 7 years were analyzed.
The distribution by gender was as follows: boys 27 (75%), girls 9 (25%). The diagnostic methods used included: computed tomography of the head with three- dimensional reconstruction of the skull, ophthalmoscopic examination on the RetCam apparatus, assessment of the neurological status; direct monitoring of intracranial pressure using the implantation of a Codman microsensor was performed in 27 cases. Results: Characteristic changes in the skull bones according to CT were found in all patients. Eight patients showed signs of intracranial hypertension according to ICP monitoring data. In 15 cases, monitoring of intracranial pressure did not make it possible to confirm the presence of intracranial hypertension – the average value of ICP was no higher than 10 mm Hg and no pathological waves were detected. According to ophthalmoscopy data, 24 children showed signs of a mild increase in ICP; 2 cases presented with congestive optic discs and in 10 patients the optic discs were normal. Operation was performed in 27 children. Simultaneous reconstructive cranioplasty was performed in 19 cases; treatment with CDA was chosen in 4 patients; and the π-shaped craniotomy was performed 4 times. The result was assessed by measuring the cephalic index before and after surgery; the assessment of the cosmetic result was carried out by both surgeons and the parents of the patients. In all cases, increased cephalic index values were noted, but the best results were achieved with reconstructive cranioplasty. Conclusions. In children over 2 years of age with sagittal craniosynostosis, clinical manifestations of intracranial hypertension may not be observed. The use of the invasive monitoring of intracranial pressure, examination of the ocular fundus allows one to reliably establish the stage of the disease. As for the surgical technique, the best result, both aesthetic and physiological, is achieved, in our opinion, after the use of one-stage reconstructive cranioplasty. However, the use of pi-plastics or the KDA technique also allows achieving good results.
Key words: sagittal craniosynostosis, scaphocephaly, ICP monitoring, late craniosynostosis Conflicts of interest.
Funding. There was no funding for this study.