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- Guimarães-Ferreira, José, 1965, et al.
(författare)
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Advances in craniosynostosis research and management.
- 2004
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Ingår i: Advances and technical standards in neurosurgery. - 0095-4829. ; 29, s. 23-83
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the present paper is to analyze the most recent advances in the field of craniosynostosis basic and clinical research and management, and to give an overview of the more frequently adopted surgical strategies. After reviewing some basic concepts regarding normal craniofacial embryology and growth, aetiopathogenesis of craniosynostosis and craniofacial dysostosis, classification and diagnosis and historical evolution of surgical treatment, the authors elaborate on a selection of topics that have modified our current understanding of and therapeutical approach to these disease processes. Areas covered include advances in molecular biology and genetics, imaging techniques and surgical planning, resorbable fixation technology, bone substitutes and tissue engineering, distraction osteogenesis and the spring-mediated cranioplasties, resorbable distractor devices, minimally invasive surgery and in utero surgery. A review of the main subtypes of craniosynostosis and craniofacial dysostosis is presented, including their specific clinical features and a commentary on the presently available surgical options.
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| 2. |
- Guimarães-Ferreira, José, 1965
(författare)
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Dynamic skull reshaping for sagittal craniosynostosis
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: The present investigation was aimed at expanding the knowledge base regarding the skull morphology in sagittal craniosynostosis and at assessing the safety and efficacy of two dynamic cranioplasty procedures, the modified pi-plasty procedure and the spring-mediated cranioplasty. Methods: The patient population consisted of children with non-syndromic sagittal craniosynostosis. (I) A group of 105 unoperated patients was studied with a com-puterized method of comprehensive cephalometric analysis. A control group of 72 children with unilateral incomplete cleft lip was used. (II) One hundred and ten patients operated on with the modified pi-plasty procedure were evaluated in terms of transfusion re-quirements and complications. Objective cephalometric outcome measures were used. The radiographic digital markings were studied. A parental questionnaire was used as a subjective aesthetical outcome assessment. (III) Eighty-two patients op-erated on with the modified pi-plasty procedure were analyzed longitudinally with the method of cephalometric analysis mentioned above. A control group of 45 chil-dren with unilateral incomplete cleft lip was used. (IV) Ten patients operated on with the spring-mediated cranioplasty were analyzed and compared to a control group of ten children operated on with the modified pi-plasty procedure. Periopera-tive variables, cephalometric outcome measures, and parental subjective esthetical outcome assessment were studied.Results: The calvarial shape in sagittal craniosynostosis differed significantly from the control, both in the lateral and in the frontal views. The following variables were significantly different: skull length (larger), width (smaller), and interorbital distance (larger). Transfusion requirements and hospital stay were significantly lower with the spring-mediated cranioplasty. Only minor complications were registered with the modified pi-plasty procedure and none in the spring procedure group. Both techniques produced significant objective changes to-wards normality in the study variables (with a greater change of the height ratio in the spring-mediated group, and lower mean transfusion requirement and hospitalization time), as well as a high degree of parental sat-isfaction. Conclusions: Sagittal synostosis was characterized by an extensive cranial vault deformity, with an essentially normal cranial base, and a widened interorbital dis-tance. Both the modified pi-plasty procedure and the spring-mediated cranioplasty were found to be safe and effective. The spring-mediated procedure was morphologically more effective than the modified pi-plasty procedure, with the additional benefit of a lower mean transfusion requirement and hospitalization time.
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