ORIGINAL
Introdução: A braquicefalia é resultado da fusão prematura bilateral da sutura coronal e pode ocorrer de forma isolada ou como parte de uma síndrome. Várias técnicas foram propostas para a correção da malformação, dentre elas o conceito de “frontal flutuante” que consiste no avanço da barra supraorbitária bilateralmente, juntamente com uma base do temporal, e remodelamento do frontal, que é fixado à barra, sem fixação posterior, constituindo o avanço fronto-orbitário. Objetivo e Métodologia: Descrever minuciosamente uma técnica eficaz para as alterações supracitadas por meio do avanço fronto-orbitário e remodelamento frontal utilizando uma craniotomia em quatro peças realizada em crianças portadoras de braquiocefalia. A correção da braquicefalia por meio do avanço fronto-orbitário e remodelamento do frontal permite o aumento do diâmetro anteroposterior do crânio e propicia que o cérebro em expansão continue o avanço, uma vez que o osso frontal encontra-se fixado apenas anteriormente. Resultados: A técnica relatada permite a divisão do osso frontal em quatro peças, de modo a facilitar o remodelamento ósseo e aumentar a área da dura-máter em contato com o osso principalmente na região temporal, diminuindo-se o espaço morto no local e promovendo um melhor resultado estético. Além disso, possibilita maior controle do seio sagital superior e veias pontes, fator essencial em cirurgias de correção de craniossinostose, em que a perda sanguínea deve ser a menor possível. Conclusão: A divisão do frontal facilita a execução da osteotomia, e até mesmo o neurocirurgião menos experiente pode obter êxito de forma segura e com total controle da hemostasia.
Introduction: Brachycephaly is the result of bilateral premature fusion of the coronal suture and can occur in isolation or as part of a syndrome. Several techniques have been proposed for the correction of the malformation, among them the concept of “floating frontal”, which consists of advancing the supraorbital bar bilaterally, together with a temporal base, and remodeling of the frontal, which is fixed to the bar, without posterior fixation, constituting the fronto-orbital advancement. Objective and Methodology: to describe in detail an effective technique for the alterations through fronto-orbital advancement and frontal remodeling using a four-piece craniotomy performed in children with brachiocephaly. Correction of brachycephaly by means of fronto-orbital advancement and frontal remodeling allows an increase in the anteroposterior diameter of the skull and allows the expanding brain to continue advancing, since the frontal bone is only anteriorly fixed. Results: The technique reported allows the division of the frontal bone into four pieces, in order to facilitate bone remodeling and increase the area of the dura mater in contact with the bone, mainly in the temporal region, reducing the dead space at the site and promoting a better aesthetic result. Furthermore, it allows greater control of the superior sagittal sinus and bridging veins, an essential factor in craniosynostosis correction surgeries, in which blood loss should be as little as possible. Conclusion: The frontal division facilitates the execution of the osteotomy, and even the less experienced neurosurgeon can be successful safely and with complete control of hemostasis.
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1 Medicine Student, Instituto de Educação Superior do Vale do Parnaíba – IESVAP, Parnaíba, PI, Brazil.
2 MD, Neurosurgeon, Pediatrics Neurosurgery, University of Sao Paulo – USP, São Paulo, SP, Brazil.
3 MD, Neurosurgeon, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil.
4 Medicine Student, Universidade Federal do Delta do Parnaíba - UFDPar, Parnaíba, PI, Brazil.
5 Medicine Student, Centro Universitário Uninovafapi, Teresina, PI, Brazil.
6 MD, Neurosurgeon, Neuro Oncologist, Sírio-Libanês Hospital, São Paulo, SP, Brazil.
Received Dec 9, 2022
Accepted Dec 20, 2022
