Nautilus: craniotomia dinâmica - nova técnica cirúrgica e resultados preliminares

Abstract

Nautilus-shaped dynamic craniotomy: a new surgical technique and preliminary resultsNautilus: craniotomia dinâmica -nova técnica cirúrgica e resultados preliminares ABSTRACT Introduction: Considering that craniosynostosis is a suture-related condition, the main challenge for its treatment is the fact that the brain is located in a closed compartment that does not have the required adaptability to accommodate its growth. The goal of treat ment is to restore stenotic suture adaptability and correct the compensatory cranial deformity. This paper proposes the combined use of spiral osteotomy with distraction osteogenesis by the use of distracting springs to remodel craniofacial defects caused by craniosynostosis. Methods: Between July 2010 and July 2012, 10 patients with craniosynostosis were treated: 5 with oxycephaly, 3 with scaphocephaly, 1 with turricephaly, and 1 with trigonocephaly. The treatment consisted of the application of Lauritzen springs to correct the primary craniosynostosis defect in combination with a nautilus-shaped spiral craniotomy at the secondary deformation sites without dural detachment. Results: Resolution of cranial deformity and remission of the clinical signs of intracranial hypertension were observed. None of the patients had complications such as cerebrospinal fluid fistula, local infection, seroma, or hematoma. Conclusions: The combined use of spiral osteotomy with spring-mediated distraction or contraction enables active reshaping of the skull and facilitates accommodation of the brain by the cranial cavity. (clinicaltrials.gov identifier: NCT01672619) Keywords: Craniosynostoses. Osteogenesis, distraction. Craniotomy. RESUMOIntrodução: Considerando-se que as craniossinostoses são afecções basicamente suturais, o fato de o cérebro estar aprisionado em um compartimento fechado, que não possui a complacência necessária para acompanhar seu crescimento, se constitui no desafio principal de seu tratamento. O objetivo do tratamento é restabelecer a complacência da sutura estenótica e corrigir a deformidade craniana compensatória. Este trabalho propõe a associação de osteotomia helicoide à distração osteogênica proporcionada pelo uso das molas distratoras para remodelar defeitos craniofaciais causados por craniossinostoses. Método: Entre julho de 2010 e julho de 2012, foram tratados 10 pacientes portadores de craniossinostoses, sendo 5 oxicefalias, 3 escafocefalias, 1 turricefalia e 1 trigonocefalia. O tratamento consistiu na aplicação de molas de Lauritzen, para corrigir a deformidade primária da craniossinostose, com a associação de craniotomia helicoide em forma de Nautilus nos sítios de deformação secundária do crânio, sem descolamento dural. Resultados: Foi observada resolução da deformidade craniana e remissão dos sinais clínicos de hipertensão intracraniana. Nenhum

Telescoping With Multiple Revolution Cranial Osteotomies in Patients With Simple Craniosynostosis

“…Similar proposals were made by Tullous et al [12] and Solís-Salgado & Anaya-Jara [13]. Cardim [14] presented excellent results with the use of springs and dynamic osteotomies (Nautilus), however, the maintenance of postoperative expansion was sometimes affected by the scalp flap or by positional effects.…”

“…By designing bone flaps in spiral osteotomies [10,12], the correction of the deformity has successful and stable outcomes. Also allowing adequate expansion of the brain in a more uniform, progressive way and obtaining a more anatomical shape [13,14].…”

Combined Dynamic Osteotomies for Craniosynostosis

“…In mature skulls, the areas of the secondary defect received nautilus-shaped helical osteotomies 5 to also remodel the force distribution. These osteotomies were already described by Salyer 14 and Salgado 15 as performed using the BTS technique on the deformed plates removed from the stenotic skulls.…”