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.

作者的目的是测量颅骨后穹窿牵张术 (PCVD) 联合枕骨大孔减压术 (FMD) 对综合征性颅缝早闭患者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的矢状窦、直窦、横窦和乙状窦体积在手术前、手术后立即和手术结束后使用 T2 加权体积 MRI 序列计算，单位为立方厘米。分心的过程。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到 12.64 cm ³）并在整个 30 天的牵引期间持续增加（从 12.64 cm ³到 14.71 cm ³) (p = 0.04)，除了右乙状窦在初始增加后保持稳定。左横窦 (+113.2%)、右横窦 (+104.3%)、左乙状窦 (+91.3%) 和矢状窦 (+41.8%) 观察到最重要的增加。右侧乙状窦 (+33.7%) 和直窦 (+23.4%) 的修改不太重要。在 PC-MRA 图像的三维重建中注意到静脉流量的显着改善。4 名患者的静脉阻塞分级评分得到改善（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症 (CTH)（平均 [范围] 16.6 [8-26] mm），3 名患有脊髓空洞症。CTH 在 4 名患者的最后一次随访 MRI 评估中显示出改善（平均 [范围] 10. 5 [0–25] mm），并在 1 名患者中从 15 mm 恶化至 19 mm。脊髓空洞症在 2 名患者中得到改善，在 1 名患者中保持不变。

这项研究提供了颅面手术对硬脑膜窦解剖和静脉引流影响的第一个放射学证据。在综合征性颅缝早闭患者中描述的静脉异常不是静态的，PCVD+FMD 触发了一个动态过程，可导致颅内静脉引流的显着改变。牵张的骨瓣对紧贴内颅盖的枕顶硬脑膜施加的牵引力可能是整个牵张期间硬脑膜窦增大的原因。这些改变对静脉压、颅内压、CTH 和脑积水的影响仍有待确定。