Single incision endoscope-assisted surgery for sagittal craniosynostosis

Abstract

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.

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

“…Their median age at surgery was between 2.6 and 3.9 months [ 25 , 33 ] with a total range from 1.5 to 7.0 months [ 22 , 35 ]. Average patient weight was reported in only 2 (18.2%) articles, given by 6.3 ± 2.1 kg [ 24 ] and 5.4 kg (range: 3.8–6.1 [ 35 ]).…”

“… Brown, 2011 [ 8 ] 52 3.08 n.g. Iyer, 2017 [ 24 ] 7 15.2 ± 7.7* 12.3* 6 ♂ 1 ♀ Iyer, 2018 [ 25 ] 31 2.7 r (1.6–3.2) 27 ♂ 4 ♀ Isaac, 2018 [ 22 ] 187 (207 in total; 187 endoscopic vs. 20 undergone CVR; data separated in article) 3.0 IQR [2.5–4.0] r (1.5–7.0) 137 ♂ 50 ♀ Jimenez, 2012 [ 28 ] 256 3.9 187 ♂ 69 ♀ Lepard, 2021 [ 33 ] 19 (50 patients in total; 19 endoscopic vs. 31 undergone open surgical correction; data separated in article) 2.6 r (2.4–2.9) 16 ♂ 3 ♀ Magge, 2019 [ 34 ] 30 (51 in total, 30 endoscopic vs. 21 undergone pi-procedure; data separated in article) 3.11 (± 3.18) n.g. Martin, 2018 [ 35 ] 5 2.8 r (1.5–4.5) 3 ♂ 2 ♀ Nguyen, 2017 [ 37 ] 100 3.3 (± 1.1) 70 ♂ 30 ♀ Ridgway, 2011 [ 39 ] 56 3.24 (± 1.48) 47 ♂ 9 ♀ Schulz, 2021 [ 42 ] 17 (128 in total: sagittal CS ( n = 17) with endoscopic treatment vs. conventional/open surgery ( n = 29); metopic CS with endoscopic treatment ( n = 16) vs. conventional/...…”

“…We looked for suggested team constellations described in the data, as well as related tasks each one of the team members had. 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 ].…”

“…The majority of surgeons performed two transverse skin incisions. In contrast, Iyer et al [ 24 ] developed a technique with a single, transverse 3-cm incision about 1 cm posterior to the anterior fontanelle — later also realized by Schulz et al [ 42 ], following which they left the pericranium intact to mark the bone using electrocautery. Burr holes were performed using a high-speed drill [ 2 , 24 , 35 , 39 , 48 ] and hereafter locally enlarged with Kerrison rongeurs [ 2 , 22 , 35 , 39 ].…”

Optimal duration of postoperative helmet therapy following endoscopic strip craniectomy for sagittal craniosynostosis

“…12,14,18,19 While technical variations exist for ESC, such as narrow versus wide vertex craniectomies, barrel-staving versus no barrel-staving, and single-incision versus multipleincision surgery, aesthetic outcomes are similar. 6,10,18,21 Nonetheless, the evolution of intraoperative techniques for ESC continues to improve surgical safety, reduce operative times, and minimize patient morbidity.…”