Treatment analysis of craniosynostosis combined with Chiari malformation in children

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-12-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.12.010

Yongjie Zhu, Gang Wang, Jun-ping He, Z. Gao, Jing Qian, D. Qiu, Lei Zheng, Xinfa Wang, Rui Zhang

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引用次数: 0

Abstract

Objective To explore the surgical method and outcome of craniosynostosis combined with Chiari malformation in children. Methods A retrospective analysis was conducted on the clinical data of 16 children with craniosynostosis combined with Chiari malformation who were admitted to Department of Neurosurgery, Children′s Hospital of Nanjing Medical University from April to December 2017. All cases were retrospectively analyzed and their imaging results were analyzed. Of the 16 children without hydrocephalus, 12 underwent craniofacial reconstruction of cranial suture or craniofacial reconstruction, of which 1 case underwent posterior fossa reconstruction and suboccipital decompression at 7 months post operation. In 4 children with combined hydrocephalus, 3 underwent routine right ventricle-peritoneal shunting and cranial reconstruction, of which 1 case was treated with posterior fossa reconstruction and suboccipital decompression at 5 months post operation. The other 1 case was Pfeiffer syndrome and underwent right ventricle-peritoneal shunting plus posterior fossa reconstruction as well as suboccipital decompression. At 3, 6 and 12 months post operation, all patients were followed up at the outpatient clinic and underwent the reexamination of head MRI for assessment of brain tissue development, ventricle changes and cerebellum tonsil herniation. Results All 16 children underwent operation successfully without any surgical complications. Revealed by the postoperative skull CT, all the children′s cranial cavity volume was enlarged, and the cranial malformation was improved. The follow-up time of 16 children was (12.1±2.0) months (10-18 months). The review of head MRI showed that brain tissue developed well and the position of the cerebellar tonsils did not decline further. All children were free of neurological deficits, and parents were satisfied with the improvement in the appearance of their skulls and faces. Conclusions The combination of craniosynostosis with Chiari malformation should be fully evaluated before surgery and appropriate individualized treatment program should be selected according to specific conditions. One-stage craniofacial surgery seems an effective treatment method. Key words: Craniosynostosis; Arnold-Chiari malformation; Child; Treatment outcome

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儿童颅缝闭闭合并Chiari畸形的治疗分析

目的探讨儿童颅缝闭合术合并Chiari畸形的手术方法和疗效。方法回顾性分析2017年4月至12月南京医科大学儿童医院神经外科收治的16例颅缝畸形合并Chiari畸形患儿的临床资料。对所有病例进行回顾性分析，并对其影像学结果进行分析。在16例无脑积水的儿童中，12例接受了颅骨缝合或颅面重建的颅面重建，其中1例在术后7个月接受了后颅窝重建和枕下减压。4例合并脑积水患儿中，3例行右心室腹膜分流及颅骨重建，其中1例术后5个月行后颅窝重建及枕下减压治疗。另1例为Pfeiffer综合征，接受了右心室腹膜分流加后颅窝重建和枕下减压。术后3、6和12个月，所有患者在门诊进行随访，并接受头部MRI复查，以评估脑组织发育、心室变化和小脑扁桃体突出。结果16例患儿均顺利完成手术，无任何并发症。术后颅骨CT检查显示，儿童颅骨腔容积均增大，颅骨畸形得到改善。16例患儿随访时间为（12.1±2.0）个月（10-18个月）。头部MRI检查显示，脑组织发育良好，小脑扁桃体的位置没有进一步下降。所有的孩子都没有神经系统缺陷，家长们对他们头骨和面部外观的改善感到满意。结论术前应充分评估合并Chiari畸形的开颅手术，并根据具体情况选择合适的个性化治疗方案。一期开颅手术似乎是一种有效的治疗方法。关键词：颅骨骨质疏松症；Arnold-Chiari畸形；儿童；治疗结果

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.