Preoperative ultrasound localization of the lambda in patients with scaphocephaly: a technical note for minimally invasive craniectomy

Abstract

<jats:p>Sagittal craniosynostosis, the most common single suture craniosynostosis, is treated by numerous surgical techniques. Minimally invasive endoscopy-assisted procedures with postoperative helmeting are being used with reports of good cosmetic outcomes with decreased morbidity, shortened hospital stay, and less blood loss and transfusion. This procedure uses small skin incisions, which must be properly placed to provide safe access to the posterior sagittal and lambdoid sutures. However, the lambda is often hard to palpate through the skin due to the abnormal head shape. The authors describe their experience with the use of intraoperative, preincision ultrasound localization of the lambda in patients with scaphocephaly undergoing a minimally invasive procedure. This simple technique can also be applied to other operations where proper identification of the cranial sutures is necessary.</jats:p>

Endoscopic treatment of sagittal suture synostosis — a critical analysis of current management strategies

“…Most studies included were retrospective in design, whereby two authors [ 28 , 44 ] reported on their prospectively analyzed sample. The number of patients presented varied between 5 and 256 [ 6 , 28 , 35 ]. In total, 885 children with isolated sagittal suture craniosynostosis were included, wherein 188 were female and 537 male (sex was only specified in 10 articles, 725 included patients respectively).…”

“…Nine series stated their procedures were carried out by a single neurosurgeon [ 8 , 22 , 24 , 25 , 28 , 32 , 33 , 38 , 47 ]. In 2 series, the decision for one or more additional craniofacial/plastic surgeons or an accompanying pediatric neurosurgery fellow to participate depended on the severity of the underlying pathology [ 6 , 35 , 37 , 44 ]. An anesthesiologist was mentioned to work solely for the group, responsible as a pediatric specialized member, in 2 reports [ 8 , 35 ].…”

Single incision endoscope-assisted surgery for sagittal craniosynostosis

“…Average operating time was 87 min and mean blood loss was 32 cm 3 . We encountered small durotomies in a single patient requiring primary repair.…”

“…In small infants with scaphocephaly, however, palpation of the lambdoid suture through the skin can be challenging, which can lead to imperfect incision placement and morbidity. Techniques have been described to attempt to mitigate this challenge with ultrasound guidance [3]. To circumvent this issue entirely, we employed a single-incision technique that allows the surgeon to approach the lambdoid suture internally and identify it directly.…”

“…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]. Traditionally, endoscope-assisted suturectomy for sagittal synostosis has involved two incisions, one at either end of the sagittal suture [12].…”