Диагностика и оценка эффективности хирургических методик лечения несиндромальных изолированных краниосиностозов у детей старше 2 лет на примере скафоцефалии и лобной плагиоцефалии

Abstract

If craniosynostosis (CS) is not diagnosed in a timely manner, the disease develops into craniostenosis. The optimal timing for surgical correction is the first 6 to 8 months of life. However, parents of children with CS over 2 years of age often seek help. The purpose of the research was to determine the optimal diagnostic tactics, to evaluate the effectiveness of existing surgical methods for treating isolated CS in children over 2 years of age using the example of the two most common forms, sagittal and hemicoronal CS. Materials and methods used: the results of treatment of 36 pediatric patients with isolated sagittal CS and 21 with hemicoronary CS aged 2 to 7 y/o were analyzed. The control group consisted of patients with CS of the younger age group (under 2 y/o). The diagnosis used computed tomography (CT) of the skull, ophthalmoscopic examination using the RetCam device, and direct invasive monitoring of intracranial pressure. Surgical treatment included one-stage reconstructive cranioplasty, Pi-shaped craniotomy and installation of compression-distraction devices. Treatment results were assessed by calculating craniometric parameters at both pre- and postoperative stages. Statistical assessment of the effectiveness of the results of various types of surgical correction was carried out as well. Results: hypertensive changes, according to CT data, were found in all patients. Intracranial hypertension was detected in 38% of cases in children with sagittal and 33% of cases in patients with hemicoronary CS. Craniometric indices after surgical treatment were statistically better in the younger age group. Conclusion: Children over 2 years of age suffering from CS may not experience clinical manifestations of intracranial hypertension. The method of direct monitoring of intracranial pressure and assessment of the condition of the fundus allow a reliable assessment of the stage of the disease. Surgical treatment of the disease should be performed during the first year of life, which gives the best both cosmetic and functional results. In the case of treatment at a later date, the most optimal results are achieved with the use of one-stage reconstructive cranioplasty.