Minimally Invasive Strip Craniectomy for Sagittal Synostosis

Abstract

The most common approaches used today for the correction of sagittal synostosis involve large craniectomies and extensive cranial vault remodeling. Although these techniques ultimately yield very good cosmetic results, they have significant drawbacks. They are lengthy, expensive, associated with significant blood loss, universally require transfusions, and often result in prolonged hospitalization.We present here our 5-year experience with correction of sagittal synostosis using the recently described minimally invasive strip craniectomy followed by postoperative cranial vault helmet molding. During this period, we treated a total of 97 children with nonsyndromic single-suture synostosis. The first 46 of 67 children treated for sagittal synostosis had at least 1 year of postoperative follow-up and were included in the analysis. There were 33 boys and 13 girls. Patients' mean age at surgery was 3.1 months, and the mean weight was 6.1 kg. The mean operative time was 75 minutes. The estimated blood loss during the procedure was 56 mL. Eight patients received blood transfusions during surgery (17.4%) and 3 patients received after surgery (6.5%). There were no significant postoperative complications. The mean hospitalization was 2.2 days. Excellent aesthetic outcomes were noted in all patients. The change in cranial index from a preoperative value of 0.7 to 0.8 postoperatively was virtually stabilized 3 months after the surgical intervention. Significantly better correction rates were observed in the youngest patients.Because of its excellent attributes, minimally invasive strip craniectomy followed by postoperative helmet molding is likely to become the preferred treatment modality for the correction of sagittal synostosis.

Long-Term Morphological Outcomes in Nonsyndromic Sagittal Craniosynostosis

“…[10][11][12][13]15,[49][50][51] In particular, those who undertake endoscopeassisted minimal access procedures combined with prolonged postoperative helmet therapy have reported good outcomes in both the short and longer term. 26,52,53 Jimenez 54 has argued that helmet molding is key to improving the CI. However, others have reported similar early results using a minimal access approach without helmet therapy after surgery, indicating that operating within the first 3 months of life is also likely to be an important factor.…”

Single incision endoscope-assisted surgery for sagittal craniosynostosis

“…Post-operatively, patients demonstrated significant correction in their CI at follow-up. In the recent decades, advances in minimally invasive endoscope-assisted techniques for sagittal synostosis have made this a widespread, durable solution for infants less than 3 months of age [8,11,12]. 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.…”

Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

“…Minimally invasive approaches constitute the majority of recently detailed techniques. 9,20,28,38,40,44,53 However, complete remodeling at a later age remains relevant since some patients will continue to present late and several centers still prefer to perform total remodeling at a later obJect Various techniques to correct sagittal synostosis have been described. The authors of this study assess the results of 2 techniques for late complete cranial remodeling and test the hypothesis that adding a widening bridge would improve outcome.…”

“…3,5,[9][10][11][12]15,17,[20][21][22][23][26][27][28][29][30][31][33][34][35][36]38,40,[43][44][45][46][47][48][49][50][51] The field continues to evolve and aims to reduce the impact of surgery. Minimally invasive approaches constitute the majority of recently detailed techniques.…”