Surgical treatment is the only effective method. The main purpose of the operation is to reconstruct a new bone sulcus by suture or craniotomy, so as to enlarge the cranial cavity and ensure the normal development of the brain. The two basic purposes of surgical treatment are to repair the normal anatomical structure of the skull and to use the powerful driving force of 1 brain development in infancy. So theoretically, the earlier the operation, the better the effect. Surgery should be performed within 7 months after birth and the prognosis is good. The later the operation, the worse the effect. It is generally believed that if the child's body permits, surgery should be performed as soon as possible after birth to relieve the narrowed cranial cavity as soon as possible, which is conducive to the development of brain tissue. If there is only 1 ~ 2 ossification of cranial suture, the operation can be performed 4 ~ 6 weeks after birth; If multiple cranial sutures ossify and intracranial pressure increases, the operation should be performed 1 week after birth to achieve success. When optic atrophy and mental retardation occur, the recovery of nerve function is not satisfactory even after surgery.

At present, there is no uniform standard for the indications of surgical treatment of cranial cavity stenosis. Because the purpose of the operation is different, its indications are also different. Surgical indications include plastic surgery indications, functional recovery indications, psychosocial indications and so on. Sometimes, psychological and social factors determine the indications of surgery, and surgery must be fully agreed by family members.

1. Indications for early cases Early surgery is the most ideal, especially within 1 year, because at this time, the brain grows vigorously, which greatly promotes the skull and forehead, is conducive to postoperative reconstruction and plays a good role in shaping. If it is not an emergency, the best age for early surgery is 6 ~ 9 months after birth. Cranial malformations during operation include oblique head malformation, triangular head malformation and navicular head malformation. If it is an emergency case, you can ignore this age limit and mainly consider the principle of ensuring that the neurological function is not damaged. Severe craniopharyngiomas, such as some triceps, navicular and diffuse microcephaly with high bone stenosis, should be operated within a few weeks after birth. Short head deformity and craniofacial stenosis should be operated within 6 months after birth, preferably within 2 ~ 3 months after birth and then after 2 ~ 3 years. It is emphasized that the operation within 1 year has the following advantages: ① it is convenient for bone flap cutting and molding; ② The bone flap is easy to assemble, and the skull defect will be quickly repaired by re-ossification; ③ Early operation of craniofacial stenosis can improve or prevent future facial deformities before they appear; ④ It can prevent neurological deficit and intracranial hypertension.

2. Surgical indications for advanced cases: 1 ~ 3 years old, children can use the continuous driving force of the brain to reshape the skull and strive for early surgical treatment. For children over 3 years old, because the vigorous growth stage of the brain has ended, the purpose of the operation is to restore craniofacial deformities or solve functional problems. Therefore, the indication of operation should be considered from the degree of craniofacial deformity and dysfunction. There are objective indications to determine the degree of deformity, but the psychological and social impact of deformity on patients must be understood through direct conversation and examination between psychologists and patients and their families. Children's self-awareness of craniofacial malformation is one of the main indications to decide whether to operate or not. Patients with neuroatrophic blindness and severe mental retardation should be carefully considered, because these secondary injuries are irreversible and there are no surgical indications. As for the slight visual and intellectual damage caused by mild intracranial hypertension, it is expected to be relieved after surgery.

The surgical method is to determine the ossified bone seam after scalp incision, then cut it linearly at the bone seam, which exceeds the adjacent normal bone seam, and insert polyethylene plastic into the bone seam to prolong the healing time of the two skulls. Another method is to cut a groove on the original suture with a width of about 1cm, cut off the early closed suture, and wrap the broken ends of both skulls with polyethylene film. The length of bone groove and capsule is longer than that of adjacent suture. This method is more effective.

3. When the forehead seam closes early, the face is upward and a coronal incision is made behind the hairline. From one zygomatic arch to the other, the flap turns forward to expose the nasal root. From the coronal suture to the nasal root, the periosteum with a width of 3cm was removed along the frontal suture, and the skull with a width of 1cm was removed, including the frontal suture, and the bleeding was stopped properly. On this basis, some scholars use rongeurs or saws to bite the skull from the middle point of the coronal suture to both sides, turn to the orbit through the temporal part, meet at the root of the nose, and free the bilateral frontal bones. The skull of frontal suture and orbital margin was wrapped with polyethylene film and then reset. 65,438+0 ~ 2 stitches were fixed on both sides of the orbit, and 65,438+0 stitches were loosely fixed between the two bone fragments, so that the bone flap would not shift, and it could bulge forward with the growth of brain tissue and maintain the normal shape of the skull.

4. The surgical position and incision of premature closure of coronal suture are the same as above. Peel off the periosteum 3cm wide along the coronal suture, take out the skull 1cm wide, which is longer than the scales on both sides, and then wrap the skulls on both sides with polyethylene film.

5. Early closure of sagittal suture is performed in lateral position. The scalp was cut along the sagittal suture, peeled off along the sagittal suture, and the periosteum with a width of 3cm was removed, and the skull with a width of 1cm was taken out, with the front exceeding the coronal suture and the back exceeding the herringbone suture. Because the superior sagittal sinus is located below the sulcus, the operation should be very careful to prevent the sinus from bleeding. You don't have to open a bone groove at the sagittal suture. You can open a bone groove with a width of 1cm on both sides of the sagittal suture, which is more than the coronal suture and herringbone suture. The bone margin is wrapped with polyethylene film, which can avoid the massive bleeding caused by the injury of the upper sagittal sinus.

6. The premature closure of herringbone suture was performed in prone position. The incision is from the last side of the sagittal suture to the back of the scale suture on both sides, and the periosteum of 3cm is also removed, and the bone groove with a width of 1cm is bitten or sawed. It is best to make a hole on both sides of the superior sagittal sinus and then bite it open to avoid damaging the superior sagittal sinus. Attention should be paid to the vicinity of mastoid process on both sides to avoid damaging the guide vein. The bone margin is wrapped with polyethylene film, and the bone groove must pass through the superior sagittal sinus.

7. The surgical method of early closure of multiple sutures is the same as above, and the surgical steps can be determined according to the position of sutures, which can be completed at one time or in multiple times. If the frontal suture is accompanied by premature closure of the coronal suture, it can be completed at one time through the coronal incision; The premature closure of coronal suture plus sagittal suture requires coronal and sagittal incision, which is completed in two times; Early closure of sagittal suture of herringbone suture requires sagittal and posterior parietal incision, which also needs to be completed twice; Suture all suture, two operations, coronal incision, posterior parietal bone incision from one ear to the other. The second operation time should be at least 1 week.

If intracranial hypertension occurs again after operation, X-ray examination shows that the skull is fused again, and the second operation can be performed 6 months after operation.

In recent years, some doctors have performed total skull reconstruction on patients with cranial stenosis. Cutting off the frontal bone first and fixing it in the normal position after correction can effectively correct the deformities of the frontal bone, orbital margin and frontal nose angle. Freeing large skull bone flaps and rearranging them at will can create a skull that conforms to the normal anatomical structure, thus opening up a new feasible way for the surgical treatment of cranial cavity stenosis.

(2) Prognosis

Different types of head malformations have different prognosis. After surgical treatment, the head deformity can be corrected to varying degrees. After the operation of navicular head deformity, the posterior deformity can disappear, and reoperation is rarely needed. Pointed deformity is often complicated with increased intracranial pressure. The effect of surgery is not only to solve the problem of beauty, but also to decompress the brain. If the cranial suture is closed again after operation, another operation is needed. Early operation can avoid or reduce brain dysfunction. If the operation can be carried out in time and reasonably, the prognosis of most patients is satisfactory, and their neurological dysfunction and skull deformity are improved, so the surgical effect has a great relationship with the surgical method. 1 year, the prognosis of patients with mental development is good; Patients in the late stage of surgery can also be significantly improved. Early operation can obviously improve skull deformity, but it is not obvious after 2 years old. In a word, most of them recovered well after operation, and they could go home from 12 to 15 days after operation, without any special care, and soon returned to normal life. But the operation is dangerous, and the mortality rate is 2.5%. The causes of death were postoperative intracranial hemorrhage, acute pulmonary edema and meningitis.