Early endoscopy-assisted treatment of multiple-suture craniosynostosis

Abstract

Endoscopy-assisted surgery for correction of craniosynostosis in children under 4 months represents a valid and safe management option. Early treatment may contribute to prevent the development of associated ventriculomegaly and Chiari I malformation.

Endoscopic surgery for patients with syndromic craniosynostosis and the requirement for additional open surgery

“…13 Few reports, however, have described the use of endoscopic suturectomy and postoperative helmet therapy for patients with syndromic craniosynostosis. 8,10,19,20 Syndromic craniosynostosis accounts for 8%-24% of all patients with craniosynostosis. Multiple syndromes exist, many of which result from 1 or more mutations in 1 of at least 57 currently recognized genes.…”

“…Indeed, among the few syndromic patients who are reported as having undergone endoscopic suturectomy and postoperative helmet therapy, almost half have required subsequent calvarial remodeling due to either persistent or recurrent deformity. 8,19,20 In these cases, one may question the utility of the primary surgery with helmet therapy if subsequent open surgery is ultimately required. We present our experience with this patient population and seek to identify factors that may contribute to the sufficiency of endoscopic surgery alone.…”

Superior Sagittal Sinus Thrombosis as a Treatment Complication of Nonsyndromic Kleeblattschädel

“…Possibly, an ETV may decrease the morbidity of the decompressive craniofacial procedure and the postoperative development of ventriculomegaly and Chiari I malformation. 16 Although several complications (eg, extensive bleeding, pneumonia, meningitis, seizures, among others) have been described in both the perioperative and postoperative periods, 4 to the best of the authors' knowledge, this is one of the few reports on SSS thrombosis after a surgical approach to Kleeblattschädel. 17 A detailed imaging study, including MRI and CT scans, should be performed to detect signs of skull base abnormalities and venous hypertension or collateral circulation that can contribute to postoperative hydrocephalus, decreasing the venous outflow that may lead to SSS.…”

“…15 If symptoms of increased ICP appear early, a VP shunt or an endoscopic third ventriculostomy (ETV) must be considered. 4,16 We and other authors 7 believe that the placement of a shunt in these patients merely redistributes the balance of the CSF without dealing with the underlying anatomic abnormalities, so its use is justified merely to gain time until a more definitive surgery can be performed. Once the VP shunt is considered a palliative treatment, along with its own morbidities, and can impair the subsequent treatment, we believe that ETV (if feasible) can be the best treatment in this early period.…”

Nursing Care of the Pediatric Neurosurgery Patient

“…Blood loss is minimal and the hospital stay is 2-3 days. This has been done successfully on the sagittal, coronal, metopic, and lambdoid sutures (and combinations thereof) with blood losses averaging less than 43 cc and usually just an overnight stay in the hospital (Cartwright et al 2003 ;Jimenez et al 2002Jimenez et al , 2004Jimenez and Barone 2010 ;Rivero-Garvia et al 2011 ) . A custom-made molding helmet, worn postoperatively, helps to reshape the head during this period of rapid brain growth, as it overcomes the dural forces that caused the original deformity ( Fig.…”