肩头畸形患者颅内压(ICP)升高的患病率存在争议。这里,基于人类学材料,我们的目的是确定非手术矢状面融合的成人是否显示出ICP增加的间接迹象.
从国家自然历史博物馆(巴黎,法国)。博物馆登记处所有登记为“融合矢状缝合线”或“到头趾”的头骨都包括在内。全部矢状缝线完全融合。在相似起源的头骨中选择对照(法国),没有明显的颅面异常.使用标准医学CT扫描对38个头骨进行了CT扫描,该扫描具有专用于干骨成像的协议。评估了与ICP升高相关的八个放射学体征:(1)颅骨和(2)颅底变薄,(3)背囊侵蚀,(4)蝶鞍延长,(5)铜打头骨,(6)缝合剥离,(7)永久性异位缝合,和(8)小额窦。根据头围评估头皮,颅骨指数,颅内容积,前鼻角,和颧骨间距离。使用线性和非线性逻辑模型来比较组。
19/21头骨矢状面滑脱明显头颅。与对照组相比,头颅颅骨的ICP标准均无明显差异。然而,5例头颅颅骨的头骨有≥3个体征,有利于ICP升高的病史。我们没有报告在患有头颅畸形的成年人中ICP间接升高的明显患病率。这些结果不允许排除早期升高的ICP或轻微延长的ICP升高的历史。尽管我们的研究结果支持这一事实,即肩头畸形与长期升高的ICP没有显着相关,个别情况(5/21),有明确的体征支持脑压迫史表明,在产生明确的证据之前,应将头颅矫正视为一种功能性手术。对非手术成年头颅畸形患者的认知评估可能有助于解决颅面手术中这个反复出现的问题。
The prevalence of increased intra-cranial pressure (ICP) in patients with
scaphocephaly is controversial. Here, based on anthropological material, we aimed to determine whether adults with non-operated sagittal synostosis show indirect signs of increased ICP.
Thirty-eight dry skulls (21 skulls with sagittal craniosynostosis and 17 controls) were selected from the collections of the National Museum of Natural History (Paris, France). All skulls registered as \'fused sagittal suture\' or \'
scaphocephaly\' in the registry of the Museum were included. All had total fusion of the sagittal suture. Controls were selected within skulls of similar origin (France), without visible craniofacial anomalies. The 38 skulls were CT-scanned using a standard medical CT-scan with a protocol dedicated to dry bone imaging. Eight radiological signs associated with raised ICP were assessed: (1) calvaria and (2) skull base thinning, (3) dorsum sellae erosion, (4) sella turcica lengthening, (5) copper beaten skull, (6) suture diastasis, (7) persistent metopic suture, and (8) small frontal sinus.
Scaphocephaly was assessed based on head circumference, cranial index, intra-cranial volume, fronto-nasal angle, and inter-zygomatic distance. Linear and non-linear logistic models were used to compare groups.
19/21 skulls with sagittal synostosis were significantly scaphocephalic. None of the criteria for ICP were significantly different in skulls with scaphocephaly relative to controls. Nevertheless, 5 individual skulls with
scaphocephaly had ≥ 3 signs in favor of a history of raised ICP. We do not report the significant prevalence of indirect signs of raised ICP in adults with scaphocephaly. These results do not allow ruling out a history of early raised ICP or of minor prolonged raised ICP. Even though our findings support the fact that scaphocephaly is not significantly associated with prolonged raised ICP, individual cases (5/21) with clear signs in favor of a history of brain compression indicate that scaphocephaly correction should be considered as a functional procedure until the production of clear evidence. Cognitive assessments of non-operated adult patients with
scaphocephaly could contribute to tackle this recurring question in craniofacial surgery.