Comparison of Open Versus Minimally Invasive Craniosynostosis Procedures From the Perspective of the Parent

Abstract

Craniosynostosis, or the premature closure of the sutures of the skull, has historically been repaired in an open manner and included extensive cranial reconstruction. In recent years, technological advancements have given surgeons the ability to perform repairs with minimal surgical invasion. With the advent of endoscopy and bioresorbable plates, recent reports [J Craniofac Surg 2002;13(4):578-82] have emphasized attempts at decreased morbidity. Recently, researchers have been able to compare the results of traditional open and minimally invasive techniques in 45 craniosynostosis cases, demonstrating decreased operating room time, blood loss, transfusions, complications, and hospital stay in minimally invasive patients [Clin Plast Surg 2004;31(3):429-42]. Many of the parameters comparing the 2 types of procedures are easily quantified and comparable, but a variety of other considerations, such as the parent's reaction to the stress of surgery, arise. The purpose of this study was to compare the effects of these surgical procedures on the parent's level of stress at the time of operation. To accomplish this, we measured stress postoperatively using the Parenting Stress Index-Short Form. Subjects undergoing surgical treatment of craniosynostosis were placed into 2 groups: open versus minimally invasive. To test for confounding factors, subjects were subcategorized for sex, parent's sex, ethnicity, and parent's marital status. Analysis of our data reveals a statistically significant decrease in total stress in the households of minimally invasive patients.

Craniosynostosis: Caring for Infants and Their Families

“…The patients must wear helmets for 6 to 8 months after surgery to help mold the cranium. 10,13,14 The goal of surgery via open craniectomy is to excise the fused suture and reconstruct the cranial vault to increase intracranial volume, avoid intracranial hypertension, and allow the brain to grow in a natural pattern. Complications of surgery 10,12,[15][16][17] are listed in Table 2.…”

“…2 Depending on the institution, the surgeon, and the clinical criteria for surgery, surgery is done via open craniectomy or via an endoscopic approach. 13,14 At Advocate Children's Hospital, Oak Lawn Campus, Oak Lawn, Illinois, open craniectomy is used for surgical reconstruction of the cranial vault via surgical resection of the closed suture and the creation of osteotomies, bone grafts, and/or use of bioresorbable plates to reconstruct the vault. The goal of surgery is reconstructive, to allow the brain to grow naturally, and is not intended to be purely cosmetic.…”

“…10 Urine output is monitored, and adequate intake and output balance is calculated. Anticipated postoperative complications and interventions 2,10,14,16,34 are listed in Table 3. A CT scan of the brain is scheduled soon after surgery to obtain a postoperative baseline and to monitor for complications such as epidural or intracranial hemorrhage.…”

Unreliability of intraoperative estimated blood loss in extended sagittal synostectomies

“…Amid the growing interest in minimally invasive approaches to craniosynostosis, 2,6,14,15,19,20,26,28,37 proponents of open craniofacial repair face the challenge of further curtailing surgical morbidity. Blood loss remains one of the greatest concerns, 35 occurring during extensive scalp dissection and, more importantly, at osteotomy sites.…”

Endoscopic-Assisted Craniosynostosis Surgery

“…Recently, more centers have undertaken this technique to enlarge their surgical options addressing skull and facial deformities. [3][4][5][6][7][8][9][10][11][12][13][14] The author presents his series of endoscopic-assisted craniosynostosis surgery at Cook Children's hospital in Fort Worth, Texas.…”