Abstract：
OBJECTIVE: As many as 5% of normocephalic children may have a prematurely fused sagittal suture, yet the clinical significance and best course of management of this finding remain unclear. Providers in the Synostosis Research Group were surveyed to create a multicenter consensus on an optimal treatment and monitoring algorithm for this condition.
METHODS: A four-round modified Delphi method was utilized. The first two rounds consisted of anonymous surveys distributed to 10 neurosurgeons and 9 plastic surgeons with expertise in craniosynostosis across 9 institutions, and presented 3 patients (aged 3 years, 2 years, and 2 months) with incidentally discovered fused sagittal sutures, normal cephalic indices, and no parietal dysmorphology. Surgeons were queried about their preferred term for this entity and how best to manage these patients. Results were synthesized to create a treatment algorithm. The third and fourth feedback rounds consisted of open discussion of the algorithm until no further concerns arose.
RESULTS: Most surgeons preferred the term \"premature fusion of the sagittal suture\" (93%). At the conclusion of the final round, all surgeons agreed to not operate on the 3- and 2-year-old patients unless symptoms of intracranial hypertension or papilledema were present. In contrast, 50% preferred to operate on the 2-month-old. However, all agreed to utilize shared decision-making, taking into account any concerns about future head shape and neurodevelopment. Panelists agreed that patients over 18 months of age without signs or symptoms suggesting elevated intracranial pressure (ICP) should not undergo surgical treatment.
CONCLUSIONS: Through the Delphi method, a consensus regarding management of premature fusion of the sagittal suture was obtained from a panel of North American craniofacial surgeons. Without signs or symptoms of ICP elevation, surgery is not recommended in patients over 18 months of age. However, for children younger than 18 months, surgery should be discussed with caregivers using a shared decision-making process.
METHODS: A four-round modified Delphi method was utilized. The first two rounds consisted of anonymous surveys distributed to 10 neurosurgeons and 9 plastic surgeons with expertise in craniosynostosis across 9 institutions, and presented 3 patients (aged 3 years, 2 years, and 2 months) with incidentally discovered fused sagittal sutures, normal cephalic indices, and no parietal dysmorphology. Surgeons were queried about their preferred term for this entity and how best to manage these patients. Results were synthesized to create a treatment algorithm. The third and fourth feedback rounds consisted of open discussion of the algorithm until no further concerns arose.
RESULTS: Most surgeons preferred the term \"premature fusion of the sagittal suture\" (93%). At the conclusion of the final round, all surgeons agreed to not operate on the 3- and 2-year-old patients unless symptoms of intracranial hypertension or papilledema were present. In contrast, 50% preferred to operate on the 2-month-old. However, all agreed to utilize shared decision-making, taking into account any concerns about future head shape and neurodevelopment. Panelists agreed that patients over 18 months of age without signs or symptoms suggesting elevated intracranial pressure (ICP) should not undergo surgical treatment.
CONCLUSIONS: Through the Delphi method, a consensus regarding management of premature fusion of the sagittal suture was obtained from a panel of North American craniofacial surgeons. Without signs or symptoms of ICP elevation, surgery is not recommended in patients over 18 months of age. However, for children younger than 18 months, surgery should be discussed with caregivers using a shared decision-making process.
摘要：
目标：多达5%的正常头颅儿童可能有过早融合的矢状缝合，然而,这一发现的临床意义和最佳治疗方案仍不清楚.对Synostosis研究小组的提供者进行了调查，以就这种情况的最佳治疗和监测算法达成多中心共识。
方法：采用四轮改进的德尔菲法。前两轮调查包括匿名调查，分发给9个机构的10名神经外科医生和9名整形外科医生，并介绍了3名患者(3岁，2年,和2个月）偶然发现的融合矢状缝线，头颅指数正常,也没有顶叶畸形。询问外科医生对该实体的首选术语以及如何最好地管理这些患者。合成结果以创建治疗算法。第三和第四轮反馈包括对算法的公开讨论，直到没有进一步的担忧出现。
结果：大多数外科医生更喜欢术语“矢状缝线过早融合”（93％）。在最后一轮结束时，所有外科医生都同意不对3岁和2岁的患者进行手术,除非出现颅内高压或乳头水肿的症状.相比之下,50％的人更喜欢在2个月大的婴儿上手术。然而,所有人都同意利用共同决策，考虑到对未来头部形状和神经发育的任何担忧。小组成员同意，年龄超过18个月的患者没有提示颅内压（ICP）升高的体征或症状，不应接受手术治疗。
结论：通过德尔菲法，一项由北美颅面外科医师组成的小组就矢状缝线过早融合的处理达成了共识.没有ICP升高的体征或症状，18个月以上的患者不建议进行手术.然而,对于18个月以下的儿童，应使用共同的决策过程与护理人员讨论手术.
方法：采用四轮改进的德尔菲法。前两轮调查包括匿名调查，分发给9个机构的10名神经外科医生和9名整形外科医生，并介绍了3名患者(3岁，2年,和2个月）偶然发现的融合矢状缝线，头颅指数正常,也没有顶叶畸形。询问外科医生对该实体的首选术语以及如何最好地管理这些患者。合成结果以创建治疗算法。第三和第四轮反馈包括对算法的公开讨论，直到没有进一步的担忧出现。
结果：大多数外科医生更喜欢术语“矢状缝线过早融合”（93％）。在最后一轮结束时，所有外科医生都同意不对3岁和2岁的患者进行手术,除非出现颅内高压或乳头水肿的症状.相比之下,50％的人更喜欢在2个月大的婴儿上手术。然而,所有人都同意利用共同决策，考虑到对未来头部形状和神经发育的任何担忧。小组成员同意，年龄超过18个月的患者没有提示颅内压（ICP）升高的体征或症状，不应接受手术治疗。
结论：通过德尔菲法，一项由北美颅面外科医师组成的小组就矢状缝线过早融合的处理达成了共识.没有ICP升高的体征或症状，18个月以上的患者不建议进行手术.然而,对于18个月以下的儿童，应使用共同的决策过程与护理人员讨论手术.
