Sagital Kraniosinostoz Tanılı Bebeklerde Endoskopik Süturektomi Sonrası Kask Tedavisinin Uzun Süreli Takibi

Yıl 2022, Cilt: 16 Sayı: 5, 445 - 450, 20.09.2022

Melek Volkan-yazıcı , Harun Demirci

https://doi.org/10.12956/tchd.1095668

Öz

Amaç: Sagital kraniosinostozlu bebekler endoskopik süturektomi ve kranial kasklar ile tedavi edilir. Kullanılan bu kaskların uzun vadeli etkileri ve kask tedavisinin tamamlanmasından sonra ortaya çıkan etkiler henüz araştırılmamıştır. Bu çalışmanın amacı, kranial kaskın uzun vadeli etkilerini ve kask tedavisinin tamamlanmasından sonra ortaya çıkan etkileri araştırmaktır.

Gereç ve Yöntemler: Çalışmaya 14 bebek dahil edildi. Bebekler ameliyat sonrası, kaskın yeniden şekillendirilmesinin tamamlanmasından sonra ve 6 aylık takipte bir 3D lazer sistemi kullanılarak değerlendirildi. Anterior-posterior(AP), medio-lateral (ML) kranial ölçümler, kranial çevre(KÇ), diyagonal ölçümler, sefalik oran(SO) ve kranial kubbe asimetri indeksi(KKAI) değerlendirildi.

Bulgular: Bebekler 35±3.4 hafta boyunca yeniden şekillendirme kaskı kullandılar. Ameliyat sonrası ve tamamlama sonuçları incelendiğinde, kranial kask kullanımı sırasında, AP, ML, KÇ ölçümlerinin, SO ve KKAI’nin istatistiksel olarak iyileştiği ve bunun sonucunda kafa şeklinin normalleştiği görülmektedir (p<0.05). Takip sonuçları incelendiğinde kranial şekil simetrisinde bozulma olmadığı ve bebeklerin kraniumlarında simetrinin büyüme devam ederken AP, ML, KÇ ölçümleri ile SO ve KKAI’nin korunduğu (p>0.05) görülmektedir.

Sonuç: Bu çalışma, kranial kask tedavisi tamamlandığında, kranial gelişimin normal oranlarda devam ettiğini göstermektedir. Uzun vadede kranial simetride herhangi bir bozulma olmadığı ve kranial kask tedavisi tamamlandıktan sonra tedavinin etkinliğinin devam ettiğini ortaya koymaktadır.
Anahtar Sözcükler: Bebek, Çocuk gelişimi, Endoskopi, Kraniosinostoz, Ortez Cihazları

Anahtar Kelimeler

Bebek, Çocuk gelişimi, Endoskopi, Kraniosinostoz, Ortez Cihazları

Destekleyen Kurum

Bulunmamaktadır

Proje Numarası

Bulunmamaktadır

The Long Term Follow Up of Helmet Therapy Following Endoscopic Suturectomy For Infants with Sagittal Craniosynostosis

Öz

Objective: Infants with sagittal craniosynostosis are treated with endoscopic suturectomy and remodeling helmets. The long term effects and the effects that occur after the completion of remodeling helmet treatment have not been investigated. The purpose of this study is to investigate the long term effects of remodeling helmet and effects that occur after the completion of remodeling helmet treatment.

Material and Methods: 14 infants were included in the study. The children were assessed post-op, after the completion of remodeling helmet and at 6 months’ follow-up using a 3D laser acquisition system. The anterior-posterior(AP), medio-lateral(ML) cranial measurements, cranial circumference(CC), diagonal measurements, cephalic ratio(CR) and cranial vault asymmetry index(CVAI) were assessed.

Results: The infants used the remodeling helmet for 35±3.4 weeks. When the post-op and completion results are examined, it can be seen that during remodeling helmet usage duration, AP, ML, CC measurements, the CR and CVAI have statistically improved, resulting in normalization of cranial shape (p<0.05). When the follow up results are examined, it can be seen that there was no deterioration in the symmetry of the cranial shape and the AP, ML, CC measurements and the CR and CVAI were preserved (p>0.05) whilst the infants’ craniums continued to grow at a normal rate.

Conclusion: The present study shows that when remodeling helmet therapy is completed, cranial development continues at normal rates. There is no deterioration in cranial symmetry in the long term, and the effectiveness of the treatment continues after the remodeling helmet therapy is completed. 

Anahtar Kelimeler

Child development, Craniosynostoses, Endoscopy, Infant, Orthotic Devices

Proje Numarası

Bulunmamaktadır

Kaynakça

• Rinkoff S, Adlard RE. Embryology, Craniofacial Growth, And Development. StatPearls [Internet]: StatPearls Publishing; 2021.
• Morriss‐Kay GM, Wilkie AO. Growth of the normal skull vault and its alteration in craniosynostosis: insights from human genetics and experimental studies. J Anat 2005;207:637-53.
• Johnson D, Wilkie AO. Craniosynostosis. Eur J Hum Genet 2011;19:369-76.
• Opperman LA. Cranial sutures as intramembranous bone growth sites. Dev Dyn 2000;219:472-85.
• Di Rocco F, Arnaud E, Renier D. Evolution in the frequency of nonsyndromic craniosynostosis. J Neurosurg Pediatr 2009;4:21-5.
• Poot M. Structural genome variations related to craniosynostosis. Mol Syndromol 2019;10:24-39.
• Kapp-Simon KA, Speltz ML, Cunningham ML, Patel PK, Tomita T. Neurodevelopment of children with single suture craniosynostosis: a review. Childs Nerv Syst 2007;23:269-81.
• Mehta VA, Bettegowda C, Jallo GI, Ahn ES. The evolution of surgical management for craniosynostosis. Neurosurg Focus 2010;29:E5.
• Persing JA, Nichter LS, Jane JA, Edgerton Jr MT. External cranial vault molding after craniofacial surgery. Ann Plast Surg 1986;17:274-83.
• Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg 1998;88:77-81.
• Iyer RR, Ye X, Jin Q, Lu Y, Liyanage L, Ahn ES. Optimal duration of postoperative helmet therapy following endoscopic strip craniectomy for sagittal craniosynostosis. J Neurosurg Pediatr 2018;22:610-5.
• Jimenez DF, Barone CM. Early treatment of coronal synostosis with endoscopy-assisted craniectomy and postoperative cranial orthosis therapy: 16-year experience. J Neurosurg Pediatr 2013;12:207-19.
• Delye H, Borstlap W, Van Lindert E. Endoscopy-assisted craniosynostosis surgery followed by helmet therapy. Surg Neurol Int 2018;9:59.
• Jin S-W, Sim K-B, Kim S-D. Development and growth of the normal cranial vault: an embryologic review. J Korean Neurosurg Soc 2016;59:192-6.
• Weathers WM, Khechoyan D, Wolfswinkel EM, Mohan K, Nagy A, Bollo RJ, et al. A novel quantitative method for evaluating surgical outcomes in craniosynostosis: pilot analysis for metopic synostosis. Craniomaxillofac Trauma Reconstr 2014;7:1-8.
• Pickersgill NA, Skolnick GB, Naidoo SD, Smyth MD, Patel KB. Regression of cephalic index following endoscopic repair of sagittal synostosis. J Neurosurg Pediatr 2018;23:54-60.
• Berry-Candelario J, Ridgway EB, Grondin RT, Rogers GF, Proctor MR. Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis. Neurosurg Focus 2011;31:E5.
• Jimenez DF, Barone CM, Cartwright CC, Baker L. Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy. Pediatrics 2002;110:97-104.
• Riordan CP, Zurakowski D, Meier PM, Alexopoulos G, Meara JG, Proctor MR, et al. Minimally invasive endoscopic surgery for infantile craniosynostosis: a longitudinal cohort study. J pediatr 2020;216:142-9. e2.
• Grummer-Strawn L, Krebs NF, Reinold CM. Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States. MMWR Recomm Rep 2010; 59:1-15.
• Fearon JA, McLaughlin EB, Kolar JC. Sagittal craniosynostosis: surgical outcomes and long-term growth. Plast Reconstr Surg 2006;117:532-41.
• Fearon JA, Ruotolo RA, Kolar JC. Single sutural craniosynostoses: surgical outcomes and long-term growth. Plast Reconstr Surg 2009;123:635-42.
• Persad A, Aronyk K, Beaudoin W, Mehta V. Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair. J Neurosurg Pediatr 2019;25:291-7.