Endoscopic-Assisted Craniosynostosis Surgery

Abstract

Over the last decade, endoscopy has been increasingly utilized in craniosynostosis surgery. In 2006, the author added endoscopy followed by helmet therapy to the treatment of young craniosynostosis patients. Since then, 73 children have been successfully treated utilizing endoscopic techniques with a transfusion rate of 23%. Most children are discharged on the first postoperative day; helmet therapy begins one week later. A helmet is worn for 4 to 6 months with one helmet replacement. Complications were limited to three reoperations to address suboptimal results, and one reoperation for a persisting skull defect. One sagittal sinus injury was addressed successfully, with resolution of a small intrasinus thrombus and no adverse brain sequelae. Although not applicable to every craniosynostosis patient, properly applied endoscopic-assisted craniosynostosis surgery is safe and effective, adding another option to the treatment armamentarium for craniosynostosis.

Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

“…[7][8][9][10]14,17,19,21,24 Traditionally, single-institution reports have limited generalizability. Additionally, clinical series that incorporate decades of data may span significant advancements in surgical techniques, technological development, and paradigm shifts in medical and surgical management.…”

“…The reported rates of blood transfusion after craniosynostosis surgery in the published literature varied between 1.7% and 100%, typically as a function of the specific surgical technique and medical institution; series with predominantly endoscopic approaches generally reported transfusion rates less than 20%, [7][8][9]21 while series with predominantly open cranial vault remodeling cases generally reported transfusion rates greater than 80%. 10,21,24 Variations in blood transfusion in the perioperative period after craniosynostosis surgery may reflect differences in surgical technique, institutional thresholds for transfusion, and type of synostosis requiring treatment.…”

Single incision endoscope-assisted surgery for sagittal craniosynostosis

“…Nonsyndromic sagittal synostosis, leading to the clinical phenomenon known as scaphocephaly, is the most common variant and occurs in approximately 5 in 10,000 live births [11,15]. 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].…”

Endoscopic Strip Craniectomy for Craniosynostosis

“…In light of this troublesome disparity, we suggest that there remains insufficient clinical evidence to summarily declare that endoscopic strip craniectomy is ''safe'' with ''minimal'' risks. 23,25,26,29 One notable limitation of the endoscopic approach is the complete dependence on strict postoperative helmet therapy, which typically lasts for 6 to 9 months or longer. 26,30 Conceptually, helmet therapy facilitates an optimal head shape by directing the growth of the brain and calvarium after excision of the synostosed suture.…”

“…17 Subsequent to its description, the use of endoscopic strip craniectomy has been reported in multiple clinical scenarios involving diverse presentations of craniosynostosis. [18][19][20][21][22][23][24][25][26] In addition to the reports of wide applicability and decreased morbidity, others have discussed the cost-effectiveness of the endoscopic approach as opposed to traditional open cranial vault remodeling. 27,28 For these reasons, endoscopic strip craniectomy with postoperative helmet therapy has been lauded by some to be a safe and effective way to treat many forms of craniosynostosis.…”