neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2017-0-4-50-58neurosurgery-499Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTОТКРЫТЫЙ РЕКОНСТРУКТИВНЫЙ СПОСОБ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ НЕСИНДРОМАЛЬНЫХ КРАНИОСИНОСТОЗОВ У ДЕТЕЙOPEN RECONSTRUCTIVE METHOD OF SURGICAL TREATMENT OF NONSYNDROMIC CRANIOSYNOSTOSIS IN CHILDRENЛетягинГ. В.LetyaginG. V.

Летягин Герман Владимирович — канд. мед. наук, врач-нейрохирург, заведующий нейрохирургическим отделением №1 (детское).

г. Новосибирск, ул. Немировича-Данченко, 132/1.

g_letyagin@neuronsk.ruКимС. А.KimS. A.

Ким Сергей Афанасьевич, врач-нейрохирург нейрохирургического отделения №1 (детское).

г. Новосибирск, ул. Немировича-Данченко, 132/1.

s_kim@neuronsk.ruДанилинВ. Е.DanilinV. E.

Данилин Василий Евгеньевич, врач-нейрохирург нейрохирургического отделения №1 (детское).

г. Новосибирск, ул. Немировича-Данченко, 132/1.

v_danilin@neuronsk.ruСысоеваА. А.SysoevaA. A.

Сысоева Анна Алексеевна, врач-невролог нейрохирургического отделения №1 (детское).

г. Новосибирск, ул. Немировича-Данченко, 132/1.

a_sysoeva@neuronsk.ruАмелинМ. Н.AmelinM. N.

Амелин Михаил Евгеньевич, к. м. н., врач-рентгенолог, заведующий отделением лучевой диагностики.

г. Новосибирск, ул. Немировича-Данченко, 132/1.

m_amelin@neuronsk.ruФГБУ «Федеральный центр нейрохирургии».Russian Federation201721042018045058Copyright © Летягин Г.В., Ким С.А., Данилин В.Е., Сысоева А.А., Амелин М.Н., 20182018Летягин Г.В., Ким С.А., Данилин В.Е., Сысоева А.А., Амелин М.Н.Letyagin G.V., Kim S.A., Danilin V.E., Sysoeva A.A., Amelin M.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/499Цель

Цель: демонстрация результатов открытых реконструктивных хирургических вмешательств при различных видах несиндромальных краниосиностозов у детей.

Материал и методы

Материал и методы: В ФГБУ ФЦН г. Новосибирск с января 2014 г. по июнь 2016 г. было проведено 57 открытых реконструктивных операций по поводу различных видов краниосиностозов. Возраст детей составил от 6 мес до 11 лет. При наличии сагиттального краниосиностоза проводили широкую декомпрессию теменных долей мозга. При одностороннем и двустороннем коронарном краниосиностозе требовалась двусторонняя лобно-теменная реконструкция с репозицией фронтоорбитального комплекса. При метопическом краниосиностозе проводили фронто-орбито-париетальную реконструкцию. При задней односторонней плагиоцефалии применяли одностороннюю парието-окципитальную реконструкцию. При сочетании поражения швов хирургическое лечение проводили по алгоритмам простых краниосиностозов. До операции всем пациентам проводили мультиспиральную компьютерную томографию с 3D-реконструкцией, по данным которой оценивали тип синостозирования, краниометрические величины и интракраниальный объем. Результаты лечения оценены через 1 год с использованием шкалы L.A. Whitacker.

Результаты

Результаты. По данным КТ-волюметрии внутричерепной объем после операции увеличился в различных диапазонах в зависимости от возраста и типа краниосиностоза. Значения цефалического индекса при скафоцефалии в среднем увеличились до 6%, изменения фронтального угла при тригоноцефалии — около 12%. Коэффициент асимметрии свода черепа при плагиоцефалии изменился до 47%. По шкале L.A. Whitacker хороший результат вмешательства отмечен в 89,5% наблюдений, удовлетворительный — в 10,5%.

Заключение

Заключение. Результаты открытых реконструктивных операций демонстрируют предотвращение развития или устранение внутричерепной гипертензии и деформации головы ребенка. При этом достижение эстетического результата наблюдалось сразу после проведенной операции. 

Objective

Objective: to demonstrate the outcomes of open reconstructive surgical interventions for treatment of various types of non-syndromic craniosynostosis in children.

Material and methods

Material and methods: authors performed 57 open reconstructive operations to treat the various types of craniosynostosis from January 2014 till June 2016. Age of children varied from 6 months till 11 years old. The wide decompression of parietal lobes was performed in case of sagittal craniosynostosis. The bilateral frontoparietal reconstruction with reposition of frontoorbital complex is required for treatment of one- and two-sided coronal craniosynostosis. Frontoorbitoparietal reconstruction was performed in case of metopic craniosynostosis, parietooccipital reconstruction was used in case of one-sided posterior plagiocephaly. Algorithms for ordinary craniosynostoses surgery were applied for treatment of combined disease of cranial sutures. Preoperatively all patients underwent multispiral computer tomoghraphy with 3D-reconstruction for estimation of synostosis type, craniometrics values and intracranial volume. Treatment outcomes were estimated in 1 year using L.A. Whitacker scale.

Results

Results. Postoperatively intracranial volume was increased in varied ranges in depends on patients’ age and types of craniosynostosis according to CT-volumetry data. Values of cephalic index in case of scaphocephaly were increased up to 6% in average, changes of frontal angle in case of trigonocephaly — about 12%, asymmetry coefficient of cranial vault in case of plagiocephaly changed to 47%. The good treatment outcome was observed in 89,5% of cases, satisfactiry — in 10,5% according to L.A. Whitacker scale.

Conclusions

Conclusions. Surgical treatment outcomes in patients underwent open reconstructive operations demonstrate the prevention of development or reversal of intracranial hypertension and deformation of child’s head. The achievement of esthetic effect was observed after operation at once. 

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The authors declare that there are no conflicts of interest present.