Endoscope-Assisted Versus Open Repair of Craniosynostosis

Chan, Jennifer; Stewart, Camille L.; Stalder, Mark W.; Hilaire, Hugo St.; McBride, Lori; Moses, Michael H.

doi:10.1097/scs.0b013e3182646ab8

Cited by 83 publications

(57 citation statements)

References 9 publications

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“…The overall costs for ESC averaged only 42% of the costs of traditional cranial vault reconstruction, whereas the early clinical results showed no difference. [25] Similar results were also reported elsewhere [26,27].…”

Section: Closed Repair: Minimally Invasive Endoscopic-assisted Strip supporting

confidence: 82%

Surgical treatment of craniosynostosis in infants

Erb

Meier

2016

Current Opinion in Anaesthesiology

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Neuroendoscopic techniques, designed to minimize surgical incision, dissection, and blood loss, are becoming efficacious and valuable alternative therapeutic options reducing the need for fluid replacement and invasive hemodynamic monitoring. Since hemorrhage represents the most important complication in open craniosynostosis repair, prevention strategies such as the use of tranexamic acid should be considered. Sufficient correction of entailed coagulopathies is crucial.

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Section: Closed Repair: Minimally Invasive Endoscopic-assisted Strip supporting

confidence: 82%

Surgical treatment of craniosynostosis in infants

Erb

Meier

2016

Current Opinion in Anaesthesiology

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“…The use of endoscope-assisted techniques with post-operative helmeting has been advantageous in the appropriately selected infants as it allows for a decrease in operative time and blood loss. In contrast, more traditional open techniques such as cranial vault remodeling are more invasive, have increased morbidity, and may require longer hospitalizations [1,7,9,17].…”

Section: Discussionmentioning

confidence: 99%

“…Endoscope-assisted suturectomy and post-operative helmet orthosis in newborns less than 3 months of age has become an increasingly widespread and favorable technique for surgical correction of single suture synostosis [2,4,5,[10][11][12]16]. This minimally invasive approach, compared to more traditional surgical techniques for craniosynostosis, such as cranial vault remodeling, relies on rapid brain growth of the newborn in addition to helmet therapy to slowly correct asymmetric head shape while allowing for decreased blood loss, anesthesia time, and hospital length of stay [7,13,14]. As endoscopic synostosis surgery becomes more widespread, iterations of improvement have led to increased precision, efficiency, and safety [3,6].…”

Section: Introductionmentioning

confidence: 99%

Single incision endoscope-assisted surgery for sagittal craniosynostosis

2016

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Objective The objective of this study is to present the novel technique and associated results of a single-incision endoscope-assisted procedure for the treatment of sagittal craniosynostosis. Methods We retrospectively reviewed the charts of infants who underwent single-incision endoscope-assisted sagittal craniectomy for craniosynostosis at our institution. Demographic data collected included patient age, blood loss, operative time, pre-and post-operative hemoglobin, pre-and post-operative cephalic index (CI), and hospital length of stay. Results Seven consecutive infants underwent surgery for sagittal craniosynostosis using a single-incision endoscopic technique. Average operative time was 87 (±10.5) minutes. Average blood loss was 32 (±13.5) cubic centimeters (cc). Post-operative hemoglobin was an average of 7.1 (±0.2) g/dL. No patients required a blood transfusion intra-operatively or in the post-operative setting. Dural tears were encountered in one patient. The average hospital length of stay was 1.4 (±1.1) days. Difference between pre-and post-operative CI was 8.4 % (±3.5; p < 0.05).Conclusions We demonstrate the novel use of a singleincision technique for endoscope-assisted sagittal craniosynostosis correction that improves upon the classically described surgical procedure by decreasing invasiveness, while allowing for excellent clinical outcomes.

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“…14 Compared with the traditional approach, minimally invasive endoscopic strip craniectomy has been reported to result in less blood loss and shorter hospital stay, and it can be performed in individuals at an earlier age. 7 The technique, however, requires helmet therapy for up to 1 year postoperatively to complete morphological correction of the calvarial vault and delay the maximal correction of shape for prolonged periods (up to 1 year).…”

Section: Discussionmentioning

confidence: 99%

Altered brain connectivity in sagittal craniosynostosis

Beckett

Brooks

Lacadie

et al. 2014

PED

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Object Sagittal nonsyndromic craniosynostosis (sNSC) is the most common form of NSC. The condition is associated with a high prevalence (> 50%) of deficits in executive function. The authors employed diffusion tensor imaging (DTI) and functional MRI to evaluate whether hypothesized structural and functional connectivity differences underlie the observed neurocognitive morbidity of sNSC. Methods Using a 3-T Siemens Trio MRI system, the authors collected DTI and resting-state functional connectivity MRI data in 8 adolescent patients (mean age 12.3 years) with sNSC that had been previously corrected via total vault cranioplasty and 8 control children (mean age 12.3 years) without craniosynostosis. Data were analyzed using the FMRIB Software Library and BioImageSuite. Results Analyses of the DTI data revealed white matter alterations approaching statistical significance in all supratentorial lobes. Statistically significant group differences (sNSC < control group) in mean diffusivity were localized to the right supramarginal gyrus. Analysis of the resting-state seed in relation to whole-brain data revealed significant increases in negative connectivity (anticorrelations) of Brodmann area 8 to the prefrontal cortex (Montreal Neurological Institute [MNI] center of mass coordinates [x, y, z]: −6, 53, 6) and anterior cingulate cortex (MNI coordinates 6, 43, 14) in the sNSC group relative to controls. Furthermore, in the sNSC patients versus controls, the Brodmann area 7, 39, and 40 seed had decreased connectivity to left angular gyrus (MNI coordinates −31, −61, 34), posterior cingulate cortex (MNI coordinates 13, −52, 18), precuneus (MNI coordinates 10, −55, 54), left and right parahippocampus (MNI coordinates −13, −52, 2 and MNI coordinates 11, −50, 2, respectively), lingual (MNI coordinates −11, −86, −10), and fusiform gyri (MNI coordinates −30, −79, −18). Intrinsic connectivity analysis also revealed altered connectivity between central nodes in the default mode network in sNSC relative to controls; the left and right posterior cingulate cortices (MNI coordinates −5, −35, 34 and MNI coordinates 6, −42, 39, respectively) were negatively correlated to right hemisphere precuneus (MNI coordinates 6, −71, 46), while the left ventromedial prefrontal cortex (MNI coordinates 6, 34, −8) was negatively correlated to right middle frontal gyrus (MNI coordinates 40, 4, 33). All group comparisons (sNSC vs controls) were conducted at a whole brain–corrected threshold of p < 0.05. Conclusions This study demonstrates altered neocortical structural and functional connectivity in sNSC that may, in part or substantially, underlie the neuropsychological deficits commonly reported in this population. Future studies combining analysis of multimodal MRI and clinical characterization data in larger samples of participants are warranted.

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Endoscope-Assisted Versus Open Repair of Craniosynostosis

Cited by 83 publications

References 9 publications

Surgical treatment of craniosynostosis in infants

Surgical treatment of craniosynostosis in infants

Single incision endoscope-assisted surgery for sagittal craniosynostosis

Altered brain connectivity in sagittal craniosynostosis

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