Endoscopic-Assisted Correction of Metopic Synostosis

Gociman, Barbu; Agko, Mouchammed; Blagg, Ross; Garlick, Jared W.; Kestle, John R. W.; Siddiqi, F.

doi:10.1097/scs.0b013e31828696a5

Cited by 31 publications

(29 citation statements)

References 20 publications

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“…We recognize that many reports from multiple other centers describe excellent results, including outstanding aesthetic outcomes and facial symmetry with a low rate of reoperation following endoscopic repair of coronal and metopic craniosynostosis, and that our reoperation rates for these diagnoses are not dissimilar to those described in children undergoing initial open approaches. 12,16,17,24,31,33,38 Minimally invasive craniosynostosis procedures typically are supplemented by the temporary insertion of expansion devices such as cranial springs or, as in this series, the use of postoperative cranial molding orthotic devices. 3,26,36 Expansion devices require a mandatory, typically very limited, secondary procedure under anesthesia to remove the implant.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience

Ore

Dilip

Brandel

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEIn this paper the authors review their 16-year single-institution consecutive patient experience in the endoscopic treatment of nonsyndromic craniosynostosis with an emphasis on careful review of any associated treatment-related complications and methods of complication avoidance, including preoperative planning, intraoperative management, and postoperative care and follow-up.METHODSA retrospective chart review was conducted on all patients undergoing endoscopic, minimally invasive surgery for nonsyndromic craniosynostosis at Rady Children’s Hospital from 2000 to 2015. All patients were operated on by a single neurosurgeon in collaboration with two plastic and reconstructive surgeons as part of the institution’s craniofacial team.RESULTSTwo hundred thirty-five patients underwent minimally invasive endoscopic surgery for nonsyndromic craniosynostosis from 2000 to 2015. The median age at surgery was 3.8 months. The median operative and anesthesia times were 55 and 105 minutes, respectively. The median estimated blood loss (EBL) was 25 ml (median percentage EBL 4.2%). There were no identified episodes of air embolism or operative deaths. One patient suffered an intraoperative sagittal sinus injury, 2 patients underwent intraoperative conversion of planned endoscopic to open procedures, 1 patient experienced a dural tear, and 1 patient had an immediate reexploration for a developing subgaleal hematoma. Two hundred twenty-five patients (96%) were admitted directly to the standard surgical ward where the median length of stay was 1 day. Eight patients were admitted to the intensive care unit (ICU) postoperatively, 7 of whom had preexisting medical conditions that the team had identified preoperatively as necessitating a planned ICU admission. The 30-day readmission rate was 1.7% (4 patients), only 1 of whom had a diagnosis (surgical site infection) related to their initial admission. Average length of follow-up was 2.8 years (range < 1 year to 13.4 years). Six children (< 3%) had subsequent open procedures for perceived suboptimal aesthetic results, 4 of whom (> 66%) had either coronal or metopic craniosynostosis. No patient in this series either presented with or subsequently developed signs or symptoms of intracranial hypertension.CONCLUSIONSIn this large single-center consecutive patient series in the endoscopic treatment of nonsyndromic craniosynostosis, significant complications were avoided, allowing for postoperative care for the vast majority of infants on a standard surgical ward. No deaths, catastrophic postoperative morbidity, or evidence of the development of symptomatic intracranial hypertension was observed.

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Section: Discussionmentioning

confidence: 99%

Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience

Ore

Dilip

Brandel

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…The development of newer, minimally invasive techniques has made the procedure safer while providing outstanding deformity correction. 20 In addition, less invasive corrections have been associated with a decrease in the cost of performing these operations. 20 A criticism of suturectomy has been a lack of hypoteloric correction.…”

mentioning

confidence: 99%

“…20 In addition, less invasive corrections have been associated with a decrease in the cost of performing these operations. 20 A criticism of suturectomy has been a lack of hypoteloric correction. However, endoscopic suturectomy has been demonstrated to be equivalent to open repairs in correcting hypotelorism.…”

mentioning

confidence: 99%

Endoscopy-assisted early correction of single-suture metopic craniosynostosis: a 19-year experience

Jimenez¹,

McGinity²,

Barone³

2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe objective of this study was to present the authors’ 19-year experience treating metopic craniosynostosis by using an endoscopy-assisted technique and postoperative cranial orthotic therapy. The authors also aimed to provide a comprehensive, comparative statistical analysis of minimally invasive surgery (MIS) versus open surgery in reports previously published in the literature (through 2014) regarding only patients with metopic synostosis.METHODSA total of 141 patients with single-suture metopic nonsyndromic craniosynostosis sutures were treated between 1998 and 2017 by endoscopically resecting the synostosed bone followed by postoperative custom cranial orthosis use. All data used in the case series were collected prospectively and stored in a secure database. A comprehensive literature review was performed that included all previous case series reporting common surgical performance measures. A statistical comparison of traditional open methods versus MIS techniques was performed with regard to age, length of hospital stay (LOS), surgical time, estimated blood loss (EBL), and transfusion rate.RESULTSThe mean age at the time of surgery in the current series was 4.1 months. The mean EBL was 33 ml (range 5–250 ml). One patient underwent an intraoperative blood transfusion and 5 underwent postoperative blood transfusion for a total transfusion rate of 4.3%. The mean operating time was 56 minutes. Ninety-eight percent of patients were discharged on the 1st postoperative day. The median size of the removed synostosed bone was 0.6 cm × 10 cm. The primary goal of achieving correction of the forehead deformity was obtained in 94% of the patients. One hundred eight patients presented with hypotelorism (76.6%). Those with a minimum 1-year follow-up achieved 99% correction (n = 97). Six patients younger than 1 year had not achieved correction at the time of follow-up (6%). There were no intra- or postoperative deaths. One patient had a temporary contact dermatitis to the helmet materials and 2 patients developed pseudomeningoceles, which were successfully treated with a lumbar drain and/or spinal tap. No patient required nor underwent a second surgical procedure. Regarding the previously published literature through 2014, the reported EBL in patients who underwent MIS versus traditional open methods was 54.7 ml versus 224 ml, respectively. The reported average age for patients undergoing MIS versus traditional open methods was 3.8 months versus 11.5 months. The average LOS for patients undergoing MIS versus traditional open methods was 1.7 days versus 3.7 days. The average reported surgical time for those undergoing MIS versus traditional open methods was 66.7 minutes versus 223.7 minutes. The transfusion rate for patients undergoing MIS versus traditional open methods was 22% versus 77%. All of the above differences demonstrated statistical significance.CONCLUSIONSThe authors’ team has safely and effectively performed 141 metopic craniosynostosis corrections over the past 19 years, with excellent outcomes. Literature review comparing metrics such as LOS, EBL, operating time, and transfusion rate demonstrates a statistically significant improvement in all commonly reported measurements. MIS techniques are safe and effective and should be offered to parents and patients as an option at craniofacial centers treating this condition.

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“…30,31 Initially used for sagittal synostosis, this strategy has also been applied in patients with metopic synostosis. 25,32–35 Appropriate concern has been raised that an endoscopic technique, which relies on brain growth and helmet therapy, does not achieve the same overcorrection as an open fronto-orbital repair. 15 Early (1 year) postoperative outcomes have shown equivalent improvement in trigonocephaly between fronto-orbital advancement and endoscopic metopic ostectomy with orthotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Anthropometric Outcomes following Fronto-Orbital Advancement for Metopic Synostosis

Patel

Skolnick

Mulliken

2016

Plastic &Amp; Reconstructive Surgery

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Background The authors’ purpose is to present changes in anthropometric fronto-orbital dimensions after surgical correction of metopic synostosis. Methods The authors retrospectively analyzed craniometric dimensions in older patients with metopic synostosis corrected by fronto-orbital advancement performed by the senior author (J.B.M.). Preoperative and postoperative linear measures (frontal breadth, cranial width, and intercanthal distance) were taken by direct anthropometry. Interdacryon distance and width of the bandeau were also recorded intraoperatively, before and after widening. Follow-up anthropometric values were compared to age- and sex-matched normative data and standard (z) scores were calculated. Results Sixteen patients met the inclusion criteria. Syndromic diagnosis was documented in five of 16 patients. Average age at the last postoperative evaluation was 8.9 ± 3.8 years (range, 4 to 16 years). Mean frontal width z-scores decreased postoperatively from 0.82 to –0.32 (p = 0.007), indicating diminished growth in this dimension. The last measured frontal width strongly correlated with the breadth of the bandeau after surgical correction but not with preoperative values. Postoperative mean cranial width diminished significantly to a more normal value. Mean intercanthal distance was normal preoperatively and remained so but was significantly greater in syndromic than in nonsyndromic cases. Conclusions Frontal growth rate is diminished in the coronal plane after fronto-orbital advancement. The authors recommend primary techniques to overcorrect the width of the bandeau and frontal region, including zygomaticosphenoid osteotomies and interpositional cranial bone grafts to advance/widen the lateral orbital rim. Continued evaluation is required to assess whether overcorrection results in normal frontotemporal shape and breadth at skeletal maturity.

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Endoscopic-Assisted Correction of Metopic Synostosis

Cited by 31 publications

References 20 publications

Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience

Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience

Endoscopy-assisted early correction of single-suture metopic craniosynostosis: a 19-year experience

Anthropometric Outcomes following Fronto-Orbital Advancement for Metopic Synostosis

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