The authors’ objective was to measure the effect of posterior cranial vault distraction (PCVD) plus foramen magnum decompression (FMD) on dural sinus volume and venous flow in patients with syndromic craniosynostosis.

The volumes of the sagittal, straight, transverse, and sigmoid sinuses of 5 consecutive patients with syndromic craniosynostosis who underwent PCVD+FMD were calculated in cubic centimeters with T2-weighted volumetric MRI sequences before surgery, immediately after surgery, and after the end of the distraction process. Tridimensional reconstructions of phase-contrast magnetic resonance angiography (PC-MRA) images were obtained with multiplanar reconstruction (MPR).

The average total volume of all dural sinuses increased immediately after surgery (from 10.06 cm³ to 12.64 cm³) and continued to increase throughout the 30-day distraction period (from 12.64 cm³ to 14.71 cm³) (p = 0.04), except that the right sigmoid sinus remained stable after the initial increase. The most important increases were observed for the left transverse sinus (+113.2%), right transverse sinus (+104.3%), left sigmoid sinus (+91.3%), and sagittal sinus (+41.8%). Less important modifications were evident for the right sigmoid sinus (+33.7%) and straight sinus (+23.4%). Significant improvements in venous flow were noted on the tridimensional reconstructions of the PC-MRA images. Venous obstruction grading score improved in 4 patients (average [range] 2.4 [ 2–5]) (p = 0.023) and remained stable in 1 patient. All patients had chronic tonsillar herniation (CTH) (mean [range] 16.6 [8–26] mm), and 3 had syringomyelia. CTH showed improvement on the last follow-up MRI evaluation in 4 patients (mean [range] 10.5 [0–25] mm) and worsened from 15 mm to 19 mm in 1 patient. Syringomyelia improved in 2 patients and remained unchanged in 1.

This study has provided the first radiological evidence of the impact of craniofacial surgery on dural sinus anatomy and venous drainage. The venous anomalies described in patients with syndromic craniosynostosis are not static, and PCVD+FMD triggers a dynamic process that can lead to significant modifications of intracranial venous drainage. The traction exerted by the distracted bone flap onto the occipitoparietal dura mater adherent to the inner calvaria may account for the enlargement of the dural sinus throughout the distraction period. The impact of these modifications on venous pressure, intracranial pressure, CTH, and hydrocephalus remains to be determined.

作者的目的是测量后颅顶牵开 (PCVD) 联合枕骨大孔减压 (FMD) 对颅缝早闭患者的硬脑膜窦体积和静脉流量的影响。

连续 5 例接受 PCVD+FMD 的综合征性颅缝早闭患者，采用 T2 加权体积 MRI 序列在术前、术后即刻和术后结束时计算矢状窦、直窦、横窦和乙状窦的体积（以立方厘米为单位）。分散注意力的过程。通过多平面重建（MPR）获得相衬磁共振血管造影（PC-MRA）图像的三维重建。

所有硬脑膜窦的平均总体积在手术后立即增加（从 10.06 cm ³至 12.64 cm ³ ），并在整个 30 天的牵引期内持续增加（从 12.64 cm ³至 14.71 cm ³ ）（p = 0.04），除了右侧乙状窦在最初增加后保持稳定。最重要的增加是左横窦 (+113.2%)、右横窦 (+104.3%)、左乙状窦 (+91.3%) 和矢状窦 (+41.8%)。右侧乙状窦 (+33.7%) 和直窦 (+23.4%) 的变化较不重要。 PC-MRA 图像的三维重建显示静脉流量显着改善。 4 名患者的静脉阻塞分级评分有所改善（平均[范围] 2.4 [2-5]）（p = 0.023），1 名患者保持稳定。所有患者均患有慢性扁桃体突出 (CTH)（平均[范围] 16.6 [8–26] 毫米），其中 3 名患者患有脊髓空洞症。 4 名患者的 CTH 较上次随访 MRI 评估有所改善（平均[范围] 10.5 [0-25] mm），1 名患者的 CTH 从 15 mm 恶化至 19 mm。 2 名患者的脊髓空洞症有所改善，1 名患者的脊髓空洞症保持不变。

这项研究首次提供了颅面手术对硬脑膜窦解剖结构和静脉引流影响的放射学证据。颅缝早闭症患者的静脉异常并不是静态的，PCVD+FMD 会触发一个动态过程，导致颅内静脉引流发生显着改变。牵引骨瓣对附着于内颅骨的枕顶硬脑膜施加的牵引力可能是整个牵引期间硬脑膜窦扩大的原因。这些修改对静脉压、颅内压、CTH 和脑积水的影响仍有待确定。