頭蓋骨縫合早期癒合症の診断と治療 Up to Date(特集 小児脳神経外科)

• Material Type: 記事
• Title: 頭蓋骨縫合早期癒合症の診断と治療 Up to Date
• Author/Editor: 原田 敦子; 久徳 茂雄
• Series Title: 特集 小児脳神経外科
• Author Heading: 原田 敦子; 久徳 茂雄
• Alternative Title: Diagnosis and Treatment of Craniosynostosis : Up to Date
• Periodical title: 脳神経外科ジャーナル / 日本脳神経外科コングレス 編
• No. or year of volume/issue: 34(4):2025.4
• Volume: 34
• Issue: 4
• Pages: 202-207
• Publication date of volume/issue (W3CDTF): 2025-04
• ISSN (Periodical Title): 0917-950X
• ISSN-L (Periodical Title): 0917-950X
• Publication (Periodical Title): 東京 : 日本脳神経外科コングレス ; 1992-
• Place of Publication (Country Code): JP
• Text Language Code: jpn
• Subject Heading: craniosynostosis; endoscopy assisted suturectomy; low-dose CT; positional plagiocephaly; sutures ultrasound
• NDLC: ZS35
• Target Audience: 一般
• Holding library: 国立国会図書館
• Call No.: Z19-3530
• Data Provider (Database): 国立国会図書館 : 国立国会図書館雑誌記事索引; https://ndlsearch.ndl.go.jp
• Bibliographic ID (NDL): 034131143; http://id.ndl.go.jp/bib/034131143
• Bibliographic Record Category (NDL): 632

• Summary, etc.: <p> Increasing concerns regarding infant head shape has led to an increase in consultations for cranial deformities, most of which are attributed to positional plagiocephaly. According to 2016 <i>Neurosurgery</i> guidelines, a diagnosis of positional plagiocephaly can be established through visual examination alone. However, differentiating between severe positional plagiocephaly and unilateral lambdoid synostosis may be challenging with visual assessment alone. Downward deviation of the affected auricle is a characteristic finding observed early in infancy with lambdoid synostosis ; therefore, it is crucial to assess the position of the ears from a posterior view. For the differential diagnosis, suture ultrasound is recommended to avoid radiation exposure, and low-dose computed tomography scanning should be considered if necessary. Approximately 15% of craniosynostosis cases are syndromic. While these syndromes are clinically diagnosed based on the accompanying symptoms, further development in genetics may allow for the genetic diagnosis of syndromes in future.</p><p> The aim of craniosynostosis treatment is to improve cranial morphology and, in cases of increased intracranial pressure owing to reduced cranial volume, lower the intracranial pressure. From 2015 to 2023, our institution performed 76 initial surgeries, encompassing 82 procedures (34 cranioplasties [41.5%] , 31 endoscopy-assisted suturectomies [37.8%] , 9 cranial vault distraction osteogeneses [11%] , and 8 open suturectomies [9.8%] ). As craniosynostosis surgery is highly invasive in infants, it is imperative to determine the advantages and disadvantages of each surgical approach when selecting a procedure. Owing to the limited circulating blood volume in infants, even minor blood loss can necessitate transfusion. To avoid blood transfusions, our institution employed oral iron supplementation, starting one month prior to surgery ; intraoperative administration of tranexamic acid ; acute normovolemic hemodilution ; and intraoperative autologous blood recovery systems. In cases where worsening cranial morphology or reduced cranial volume was observed, reoperation may have be required. At our institution, there were eight cases of reoperation, with all cases attributed to reduced cranial volume.</p><p> Through incorporating the latest knowledge regarding the diagnosis and surgical management of craniosynostosis, we aimed to ensure an accurate diagnosis while avoiding unnecessary radiation exposure ; and to perform safe, minimally invasive, and effective surgeries to improve cranial morphology.</p>; <p> 乳児の頭の形への関心の高まりから頭蓋変形を主訴とした受診が増加しているが, そのほとんどが向き癖による頭位性頭蓋変形である. 重度の頭位性斜頭と片側ラムダ縫合早期癒合症の鑑別は難しいことがあるため, それぞれの特徴を認識しておく必要がある.</p><p> 頭蓋骨縫合早期癒合症の治療の目的は, 頭蓋形態と頭蓋容積の狭小化を改善することである. 乳児にとって癒合症の手術は侵襲が大きいため, それぞれの術式の利点と欠点を理解して術式選択を行う. 癒合症の診断と治療についての最新の知識を取り入れることにより, 無用な放射線被曝を避けつつ癒合症を確実に診断し, 安全で低侵襲かつ頭蓋形態の改善も得られるような手術を行っていきたい.</p>
• DOI: 10.7887/jcns.34.202
• Access Restrictions: インターネット公開
• Data Provider (Database): 科学技術振興機構 : J-STAGE; http://www.jstage.jst.go.jp

• Summary, etc.: <p> 乳児の頭の形への関心の高まりから頭蓋変形を主訴とした受診が増加しているが, そのほとんどが向き癖による頭位性頭蓋変形である. 重度の頭位性斜頭と片側ラムダ縫合早期癒合症の鑑別は難しいことがあるため, それぞれの特徴を認識しておく必要がある.</p><p> 頭蓋骨縫合早期癒合症の治療の目的は, 頭蓋形態と頭蓋容積の狭小化を改善することである. 乳児にとって癒合症の手術は侵襲が大きいため, それぞれの術式の利点と欠点を理解して術式選択を行う. 癒合症の診断と治療についての最新の知識を取り入れることにより, 無用な放射線被曝を避けつつ癒合症を確実に診断し, 安全で低侵襲かつ頭蓋形態の改善も得られるような手術を行っていきたい.</p>
• DOI: 10.7887/jcns.34.202; https://doi.org/10.7887/jcns.34.202
• Related Material (URI): http://id.ndl.go.jp/bib/034131143; https://ndlsearch.ndl.go.jp/books/R000000004-I034131143; https://www.jstage.jst.go.jp/article/jcns/34/4/34_202/_pdf
• References: Clinical Classification of Positional Plagiocephaly; https://cir.nii.ac.jp/crid/1360016869345284352; Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Diagnosis of Patients With Positional Plagiocephaly; https://cir.nii.ac.jp/crid/1360026341491814016; Systematic Review of Interventions for Minimizing Perioperative Blood Transfusion for Surgery for Craniosynostosis; https://cir.nii.ac.jp/crid/1360307816502014720; Low-Dose CT for Craniosynostosis: Preserving Diagnostic Benefit with Substantial Radiation Dose Reduction; https://cir.nii.ac.jp/crid/1360589290460062848; Craniosynostosis: Genetic Basis, Genes, Chromosomes, and Resulting Syndromes; https://cir.nii.ac.jp/crid/1360589291281633536; Use of blood-sparing surgical techniques and transfusion algorithms: association with decreased blood administration in children undergoing primary open craniosynostosis repair; https://cir.nii.ac.jp/crid/1360589291469050368; Cranial Suture Measurement by 2-point Method in Ultrasound Screening of Craniosynostosis; https://cir.nii.ac.jp/crid/1360863724006753920; The Differential Diagnosis of Posterior Plagiocephaly: True Lambdoid Synostosis versus Positional Molding; https://cir.nii.ac.jp/crid/1361699996083251328; Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis; https://cir.nii.ac.jp/crid/1363388845822081536; Wider Suturectomy Before Posterior Distraction for Craniosynostosis; https://cir.nii.ac.jp/crid/1363951796182418304; Posterior Cranial Vault Distraction Osteogenesis with Barrel Stave Osteotomy in theTreatment of Craniosynostosis; https://cir.nii.ac.jp/crid/1390001205057043072; 頭蓋縫合早期癒合症に対するMCDO法治療; https://cir.nii.ac.jp/crid/1390022487765473408
• Data Provider (Database): 国立情報学研究所 : CiNii Research; https://cir.nii.ac.jp/
• Original Data Provider (Database): Japan Link Center; https://japanlinkcenter.org/top; 雑誌記事索引データベース; https://ndlsearch.ndl.go.jp; Crossref; https://www.crossref.org
• Bibliographic ID (NDL): 034131143; http://id.ndl.go.jp/bib/034131143