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<JournalTitle>Ciencia e Innovación en Salud</JournalTitle>
<Titles>
<Title>SCAPHOCEPHALY FOR A QUICK READING</Title>
<Title>ESCAFOCEFALIA: A PROPOSITO DE UNA LECTURA RÁPIDA</Title>
</Titles>
<EditorInChief>Isaac Kuzmar, editor@revcis.com</EditorInChief>
<AcademicEditor>Henry González</AcademicEditor>
<Doit>10.17081/innosa.4.1.2441</Doit>
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</QR>
<Published>28 April 2017</Published>
<Submitted>17 August 2016</Submitted>
<Accepted>15 January 2017</Accepted>
<Abstract>SCAPHOCEPHALY FOR A QUICK READING
<Background>Craniosynostosis consists of partial or total premature closure of one or more cranial sutures; And in the context of primary craniosynostosis, scaphocephaly or sagittal craniosynostosis is the most frequent and known form.</Background>
<Methods>A 6-month and 7-day-old male infant with a diagnosis of scaphochyma was described at the Napoleón Franco ParejaChildren´s Hospital (HINFP) in Cartagena-Colombia.The patient seemed to be asymptomatic at the time of the consultation and the diagnosis was made with suggestive findings during the physical examination, taking into account the head morphology and the performance of a computerized axial tomography of the skull.</Methods>
<Discussion>Craniosynostosis presents with different clinical findings, depending on the extent and number of fused sutures. These range from aesthetic alterations to functional symptoms, such as increased cranial pressure, hydrocephalus, visual impairment and neuropsychiatric disorders. The treatment of craniosynostosis is surgical. This should be done early, before the 12 months of age, in order to decompress and reshape the skull, as well as to decrease endocranial pressure preventingpatient´s vital development problems.</Discussion>
</Abstract>
<Abstract>SCAPHOCEPHALY FOR A QUICK READING
<Introducción>Las craneosinostosis consisten en el cierre prematuro parcial o total de una o más suturas craneales; y en el contexto de las craneosinostosis primaria, la escafocefalia o craneosinostosis sagital es la forma más frecuente y conocida.</Introducción>
<Métodos>A continuación, se describe un caso clínico de un lactante menor masculino de 6 meses y 7 días de edad con diagnóstico de escafocelia, sucedido en el Hospital Infantil Napoleón Franco Pareja (HINFP) de Cartagena-Colombia. El paciente asintomático al momento de la consulta y el diagnóstico fue realizado con hallazgos sugestivos durante el examen físico, teniendo en cuenta la morfología de la cabeza, y la realización de tomografía axial computarizada de cráneo.</Métodos>
<Discusión>La craneosinostosis se presenta con diferentes cuadros clínicos, dependiendo de la extensión y número de suturas fusionadas. Estos comprenden desde alteraciones estéticas a síntomas funcionales, tales como aumento de la presión craneal, hidrocefalia, déficit visual y trastornos neuropsiquiátricos. El tratamiento de las craneosinostosis es eminentemente quirúrgico. Este debe realizarse tempranamente, antes de los 12 meses de edad con el objetivo es descomprimir el cráneo y remodelarlo, así como disminuir la presión endocraneana, para prevenirproblemas en el desarrollo vital del paciente.</Discusión>
</Abstract>
<Background><p class="line" id="line-1">L<span style="font-family: Arial;">as craneosinostosis consisten en el cierre prematuro parcial o total de una o más suturas craneales. Se clasifican en primarias y secundarias. Las craneosinostosis primarias ocurren en el periodo prenatal y el 85 %de estasnoson sindrómicas (aisladas en individuos normales), mientras que el 15 % sí lo son (pertenecen a síndromes poliformativos). Entre el 70 y 85% de las craneosinostosis no sindrómicas son simples (afectan a una sutura) y el 20-25 % restantes son multisuturales </span><i>(Tirado, 2016).</i></p><p class="line" id="line-5"><span style="font-family: Arial;">La craneosinostosis afecta 1 de cada 1000 a 2500 nacidos vivos, con mayor prevalencia en varones, y en el contexto de las craneosinostosis primaria, la escafocefalia o craneosinostosis sagital es la forma más frecuente y conocida </span><i>(Tirado, 2016).</i></p><p class="line" id="line-8"><span style="font-family: Arial;">Al presentarse en un período de vida en que el crecimiento cráneo cerebral es fundamental ocasiona en los niños una deformidad craneal característica que debe ser corregida, ya que por ser progresiva la afectación estética puede ser muy indeseable. Además, por causa de ella, se puede presentar aumento de la presión intracraneana, hidrocefalia, deterioro mental, anormalidades visuales, pérdida </span><span style="font-family: Arial; text-align: justify;">de la audición, afección psicológica y convulsiones </span><i>(Tirado, 2016).</i></p><p class="line" id="line-12"><span style="font-family: Arial;">A continuación, se describe un caso de un lactante menor masculino de 6 meses de edad con escafocefalia, sucedido en el Hospital Infantil Napoleón Franco Pareja (HINFP). El paciente aparecía asintomático al momento de la consulta y fue emitido para evaluación por presentar la cabeza alargada.</span></p></Background>
<authors>
<author> , E-mail:
<affiliationId>1</affiliationId>
</author>
<author> , E-mail:
<affiliationId>2</affiliationId>
</author>
<author> , E-mail:
<affiliationId>2</affiliationId>
</author>
<author> , E-mail:
<affiliationId>1</affiliationId>
</author>
</authors>
<copyright>2017 Tirado et al.</copyright>
<affiliationsList>
<affiliationName>Facultad Ciencias de la Salud, Departamento de Posgrado Cuidados Intensivos Pediátricos, Universidad de Santander, Bucaramanga, Colombia.</affiliationName>
<affiliationName>Hospital Infantil Napoleón Franco Pareja, Facultad Ciencias de la Salud, Departamento de Pediatría, Universidad de Cartagena, Cartagena Colombia.</affiliationName>
</affiliationsList>
<keywords>
<keyword>Synostosis</keyword>
<keyword>craniosynostosis</keyword>
<keyword>skull</keyword>
</keywords>
<keywords>
<keyword>Sinostosis</keyword>
<keyword>craneosinostosis</keyword>
<keyword>cráneo</keyword>
</keywords>
<References>
<Reference>Bagchi AK. Craniosynostosis. A problem in neurophatology. Internat Surg. 1967; 48:1-10.</Reference>
<Reference>Czerwinski M, Hopper RA, Gruss J FJ. Major morbidity and mortality rates in craniofacial surgery: an analysis of 8101 major procedures. Plast Reconstr Surg United States. 2010; 126(1):181-186. </Reference>
<Reference>Delashaw JB, Persing JA, Broaddus WC JJ. Cranial vault growth in craniosynostosis. J Neurosurg Publ Gr. 1989; 70(2):159-165.</Reference>
<Reference>Mathijssen IMJ. Guideline for care of patients with the diagnoses of craniosynostosis: Working group on craniosynostosis. J Craniofac Surg. Lippincott Williams y Wilkins. 2015; 26(6):1735-1807. </Reference>
<Reference>Palafox D, Ogando-Rivas E, Herrera-Rodríguez DL QG. Malformaciones craneofaciales. De las bases moleculares al tratamiento quirúrgico. Rev Med Hosp Gen Méx. 2012; 75(7):50-59. </Reference>
<Reference>Starr JR, Collett BR, Gaither R, Kapp-Simon KA, Cradock MM, Cunningham ML. Multicenter study of neurodevelopment in tree-year-old children with and without single-suture craniosynostosis. Arch Pediatr Adolesc Med United States. 2012; 166 (6):536-542. </Reference>
<Reference>Tapadia MD, Cordero DR HJ. It’s all in your head: new insights into craniofacial development and deformation. J Anat Engl. 2005; 207(5):461-477.</Reference>
<Reference>Tirado-Pérez IS, Sequeda-Monterrosa JF, Zarate-Vergara AC. Craneosintosis: Revisión de literatura. Rev Univ. salud. 2016; 18(1):182-189.</Reference>
<Reference>Ursitti F, Fadda T, Papetti L, Pagnoni M, Nicita F, Iannetti G. Evaluation and management of nonsyndromic craniosynostosis. Acta Paediatr. 2011; 100(9):1185-1194. http://www.uabcs.mx/geologia/geo_bajamx/LaTeX/Primera-sesion.pdf</Reference>
<Reference>Vega GML. Craneosinostosis sagital: A propósito de un caso . Pediatría Atención Primaria. 2012; 149-152. </Reference>
</References>
<Contents>
<Content>
<Title>II CASO CLÍNICO</Title>
<Body><p class="line" id="line-1">Paciente de 6 meses que ingresa al servicio de consulta externa de HINFP remitido "porque el niño tiene la cabeza larga". Antecedente prenatal: producto del segundo embarazo a término controlado de la madre, parto por vía vaginal sin complicaciones, con peso de 3550 gramos y buen Apgar Desarrollo psicomotor: sostén cefálico (2 meses), sonrisa social, lenguaje (bisílabas), se sienta sin apoyo; con antecedentes familiares de parte de un tío materno con morfología cefálica semejante, la madre refiere tener otros familiares que padecen de anemia de células falciformes. Al realizar el examen físico, se encontró un paciente en buenas condiciones generales y musculo-nutricionales, pero al hacerse inspección de la cabeza del paciente se observacrecimiento anormal del cráneo, con alargamiento en el plano anteroposterior y limitación en el crecimiento transversal del mismo; además, se observa región frontal prominente <b>(Figura 1)</b>.</p><p class="line" id="line-5">Se palpa fontanela anterior puntiforme de aproximadamente 1x1cm sin abombamiento, orejas con buena implantación, sin malformaciones en región facial; tampoco se perciben soplos en la auscultación cardiaca y presenta un abdomen blando, sin masas ni megalias. Por último, las extremidades son eutróficas y no hay déficit aparente del sistema nervioso central.</p></Body>
</Content>
<Content>
<Title>Figura 1 - Paciente a los 6 meses de edad, antes de tratamiento quirúrgico</Title>
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</Body>
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<Body><p class="line" id="line-1"><span style="font-family: Arial; : 12pt;">Se realizan exámenes de laboratorio con los siguientes resultados: Hemograma: Hemoglobina 10 grsleucograma 13300, siclemia: Negativa, tomografía cerebral simple: Sinostosis de sutura sagital <b>(Figura 2)</b>, diferenciación de sustancia blanca y sustancia gris, sistema ventricular normal. Se realiza diagnóstico de: Lactante menor eutrófico, Escafocefalia, Riesgo para neurodesarrollo.</span></p></Body>
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<Content>
<Title>Figura 2 - TAC cerebral concluye: Sinostosis de sutura sagital</Title>
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</Body>
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<Content>
<Body><p class="line" id="line-1"><span style="font-family: Arial; : 12pt;">Al ser valorado por oftalmología y neurocirugía pediátrica, los especialistas deciden de manera unánime someter al paciente a tratamiento quirúrgico con manejo interdisciplinario. Seguidamente, el paciente es intervenido sin complicaciones, actualmente acude a controles esporádicos para su seguimiento y </span><span style="font-family: Arial; : 12pt; text-align: justify;">control.</span></p><p class="line" id="line-4"><span style="font-family: Arial; : 12pt;">Esto último se correlaciona con el caso clínico expuesto. Sin embargo, es muy importante tener en cuenta que normalmente una intervención quirúrgica temprana en los casos de craneosinostosis se realiza entre los 9 meses y 1 año de edad. Aun así, se recalca que el paciente fue intervenido de manera  oportuna a los 6 meses de edad con excelentes resultados a largo plazo como se puede apreciar en la <b>Figura 3.</b></span>  </p></Body>
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<Content>
<Title>Figura 3 - Paciente a los 12 meses de edad, luego de tratamiento quirúrgico</Title>
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</Body>
</Content>
<Content>
<Title>III DISCUSIÓN</Title>
<Body><p class="line" id="line-1"><span style="font-family: Arial; : 12pt;">Como se mencionó anteriormente, la escafocefalia se define como el cierre precoz y exclusivo de la sutura sagital que separa los parietales, lo que trae como consecuencia una cabeza alargada en sentido antero posterior. Las complicaciones son infrecuentes, entre las más graves se resalta la hipertensión endocraneana. Por otra parte, la sinostosis de la sutura sagital es la más frecuente, seguida por la coronal, en tanto que la fusión prematura de las suturas metópica y lambdoidea es menos </span><span style="font-family: Arial; : 12pt; text-align: justify;">frecuente <i>(Bagchi,1967; Czwerwinski, 2010; Vega, 2012). </i></span></p><p class="line" id="line-5"><span style="font-family: Arial; : 12pt;">Las craneosinostosis no sindromáticas involucran factores mecánicos y alteraciones en la producción de factores de inhibición. Entre los factores mecánicos se describe la restricción intrauterina por mal posición fetal o por oligodramnios. Los factores relacionados con la presencia de fusión prematura son: el factor de crecimiento fibroblástico y el factor de transcripción Homebox. Las proteínas relacionadas con todo ello son la proteína ósea morfogénica y la Sonic Hedgehog. En estudios recientes se ha propuesto que la duramadre envía señales de inhibición para mantener abiertas las suturas, a través de un factor </span><span style="font-family: Arial; : 12pt; text-align: justify;">inhibitorio no identificado <i>(Tirado, 2016; Delashaw, 1989; Tapadia, 2005)</i>.</span></p><p class="line" id="line-10"><span style="font-family: Arial; : 12pt;">Hay evidencia de una correlación clara entre el momento de expresión de la proteína Sonic Hedgehog (SHH) adecuado para el desarrollo de tejidos epiteliales y craneofacial normal. Pero, ¿qué procesos celulares afectan la expresión SHH en un determinado periodo que resulta vital en el desarrollo de una adecuada formación craneofacial?. Se conoce que la señalización de SHH impacta claramente la proliferación celular y el crecimiento del proceso frontonasal; pero el moldeo de los primordioscraneofaciales en estructuras faciales requiere no sólo la proliferación celular, sino también la inducción de la muerte celular en los lugares adecuados y, lo que quizás es más importante, la supervivencia de las </span><span style="font-family: Arial; : 12pt; text-align: justify;">células en otros lugares claves. La formación del complejo craneofacial es un proceso complicado. Las células de la cresta neural que forman los elementos esqueléticos se requieren no sólo para que estos sobrevivan y proliferen, sino también para continuar el proceso de diferenciación adecuadamente. Estudios recientes han descubierto el omnipresente factor SHH</span><i style="font-family: Arial; : 12pt; text-align: justify;">,</i><span style="font-family: Arial; : 12pt; text-align: justify;"> implicado incluso en la diferenciación posterior de las células de la cresta neural. En este sentido, se ha descubierto que la cresta neural juega un papel muy importante en la producción de estructuras faciales y que algunas poblaciones de dicha cresta requieren instrucciones de su entorno local. En los casos en los que, por ejemplo, un código de Hox dicta plasticidad, las señales complejas provienen del medio local del ectodermo superficial, el neuroepitelio y el endodermo faríngeo. Entre estos tejidos el desarrollo embrionario temprano involucra vías de señalización comunes tales como las vías de SHH, FGF, WNT y BMP <i>(Palafox, 2012; Starr 2012; Tapadia, 2005).</i></span></p><p class="line" id="line-16"><span style="font-family: Arial; : 12pt;">La dependencia y la independencia compartidas por el cerebro y la cara en la embriogenia pueden explicar por qué el cerebro y las malformaciones faciales se presentan a menudo en conjunto, aunque también puede presentarse un desarrollo facial anormal en el marco de un cerebro aparentemente normal. Por otra parte, las fusiones prematuras de la sutura impiden el proceso de crecimiento del cráneo durante un período de desarrollo rápido del cerebro, alterando así la morfología y  posiblemente el aumento de la presión intracraneal. El cierre de la sutura sagital precoz, craneosinostosis, sigue en debate en cuanto a la afectación del desarrollo cognoscitivo normal; pues, en general, la evidencia acumulada sugiere que la mayoría de los niños que se encuentran en estas circunstancias arrojan resultados de pruebas </span><span style="font-family: Arial; : 12pt; text-align: justify;">cognitivas y exámenes del desarrollo neurológico en el rango normal <i>(</i></span><i style="font-family: Arial; : 16px;">Starr 2012; Tapadia, 2005</i><span style="font-family: Arial; : 12pt; text-align: justify;"><i>)</i>.</span></p><p class="line" id="line-23"><span style="font-family: Arial; : 12pt;">El tratamiento de las craneosinostosis es eminentemente quirúrgico. Está indicado para evitar la presencia de hipertensión endocraneana, atrofia del nervio óptico, retraso del desarrollo psicomotor, fines estéticos y para permitir un crecimiento del cerebro sin restricciones. El tratamiento debe realizarse tempranamente, antes de los 12 meses de edad, con el objetivo de descomprimir el cráneo y remodelarlo, así como disminuir la presión endocraneana, y prevenir problemas visuales y del desarrollo mental. Incluso algunos casos severos </span><span style="font-family: Arial; : 12pt; text-align: justify;">requieren de cirugía en los primeros días o semanas de nacidos <i>(Palafox, 2012; Mathujssen, 2015; Ursitti, 2011).</i></span></p><p class="line" id="line-27"><span style="font-family: Arial; : 12pt;">En conclusión, la escafocefalia es la craneosinostosis más frecuente en nuestro medio. El diagnóstico precoz de esta patología es fundamental, ya que aún cuando tiene una mínima mortalidad, la pronta intervención ayuda a los buenos </span><span style="font-family: Arial; : 12pt; text-align: justify;">resultados que se obtienen a largo plazo.</span></p><p class="line" id="line-30"><span style="font-family: Arial; : 12pt;">Al paciente del caso clínico aquí expuesto, luego del diagnóstico se le realizó una valoración interdisciplinaria, entre las especialidades de neurocirugía pediátrica, oftalmología pediátrica y el apoyo de trabajo social. Las tres instancias decidieron realizar tratamiento quirúrgico de manera conjunta para evitar principalmente alteraciones visuales y del desarrollo mental, lo cual coincide con las pautas establecidas en la revisión de la literatura médica concreta. Luego de la intervención quirúrgica, el paciente sigue acudiendo paciente a control y seguimiento por consulta externa, sin presentarse hasta </span><span style="font-family: Arial; : 12pt; text-align: justify;">ahora complicaciones ni alteraciones relacionadas con escafocefalia. </span><span style="font-family: Arial; : 12pt;">El reconocimiento temprano del cierre prematuro de las suturas del cráneo puede ayudar al reconocimiento y diagnóstico de esta patología; lo cual ayuda a establecer estrategias terapéuticas correctas basadas en la evidencia y guías internacionales, como se procedió en el caso descrito, lo cual incidió en los </span><span style="font-family: Arial; : 12pt; text-align: justify;">resultados con  un buen pronóstico.</span></p></Body>
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Copyright (c) 2017 Irina Suley Tirado Pérez, José Fernando Sequeda Monterroza, Karen Lucía Paternina Arrieta, Andrea Carolina Zárate

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