Uvod: Kraniosinostoze su oboljenja koja se karakterišu patološkom prevremenom
fuzijom jedne ili više kranijalnih sutura usled čega dolazi do nastanka abnormalnog oblika
lobanje, intrakranijalne hipertenzije i poremećaja neurokognitivnog razvoja obolele dece.
Cilj: Ova doktorska teza ima za cilj evaluaciju rezultata lečenja modifikovanim hirurškim
tehnikama u tretmanu unisuturnih i kompleksnih kraniosinostoza, koja podrazumeva:
1. detaljan prikaz novih modifikovanih hirurških tehnika: trikvadratna proširena
osteotomija (triple square extended osteotomies, TSEO), dinamička remodelacija sa
plivajućim čelom (floating forehead dynamic remodeling, FFDR) i frontoorbitalna
hiperkorektivna remodelacija (fronto-orbital hypercorrective remodeling, FOHR)
2. procenu estetskih rezultata hirurškog lečenja prema standardnim klasifikacijama
3. procenu morfološkog ishoda hirurškog lečenja
4. neurokognitivnu evaluaciju operisanih pacijenata
Materijal i metode: Ukupno 187 pacijenata sa prevremenim srastanjem jedne ili više
kranijalnih sutura hirurški su lečeni u Klinici za neurohirurgiju KCS u Beogradu od
januara 1999. do januara 2014. godine. Kod svih pacijenata sprovedena je adekvatna
preoperativna neuroradiološka evaluacija, koja je podrazumevala nativni kraniogram i
kompjuterizovanu tomografiju glave; magnetna rezonanca nije rutinski rađena i bila je
razmatrana isključivo za sindromske slučajeve. Klinički parametri dobijeni su iz istorija
bolesti i služili su za formiranje detaljnog upitnika. Kraniometrijske referentne vrednosti
od interesa: preoperativni i postoperativni kranijalni indeks (CI), endokranijalni
bifrontalni ugao (EBA) i modifikovani indeks za procenu simetrije kranijuma (modified
cranial vault asymmetry index - mCVAI) korišćene su za morfološku procenu uspešnosti
lečenja. Estetski rezultat lečenja evaluiran je Whitakerovom i Sloanovom klasifikacijom.
Prisutni neurokognitivni poremećaj, zaostajanje u psihomotornom razvoju, kao i
intelektualnom funkcionisanju, procenjivan je korišćenjem Razvojnog testa Čuturić,
REVISK skale i testa NEPSY-II...Introduction: The term craniosynostosis refers to premature fusion of one of more
cranial sutures that can lead to severe craniofacial disfigurement, intracranial
hypertension and abnormal neurocognitive development in affected children.
Aim: The present thesis has the intention to evaluate results of modified surgical
techniques used in the treatment of unisutural and complex craniosynostosis that
comprises of:
1. Detailed presentation of the new modified surgical techniques: triple square extended
osteotomies (TSEO), floating forehead dynamic remodeling (FFDR) and frontoorbital
hypercorrective remodeling (FOHR) techniques
2. Estimation of the aesthetic results after surgical treatment according to standard
classifications
3. Estimation of morphological outcome of surgical treatment
4. Neurocognitive evaluation of treated patients
Material and method: A total of 187 consecutive patients with premature fusion of
one or more cranial sutures were surgically treated in Clinic of Neurosurgery KCS in
Belgrade from January 1999 to January 2014. All patients underwent preoperative
neuroradiological evaluation with plain cranial radiography and computerized
tomography; magnetic resonance was not routinely performed and was considered strictly
for syndromes. Clinical data were extracted from patient's medical history and
comprehensive patient interview. Craniometrical referent points of interest: preoperative
and postoperative cranial index (CI), endocranial bifrontal angle (EBA) and modified
cranial vault asymmetry index (mCVAI) changes were used to estimate morphological
outcome of surgery. Aesthetic outcome was assessed using Whitaker and Sloan
classification. Presence of neurocognitive impairment, delay in psychomotor
development and intellectual functioning were assessed with Cuturic developmental test,
REVISK scale and NEPSY-II test..
