Endoscopic-assisted repair of craniosynostosis

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The goal of the craniofacial surgeon has always been the correction of form and function with prevention of associated morbidity and death. Through the pioneering work of Jimenez and Barone, minimally invasive approaches to the surgical correction of craniosynostosis are now gaining wider acceptance. Here the authors review the technique for endoscopic-assisted repair of craniosynostosis from the perspective of a new minimally invasive approach. They also assess the safety, efficacy, and results of the early treatment of infants with craniosynostosis in a small series of children who underwent surgery at this institution.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Data regarding synostosis type, operative time, patient age, blood loss, transfusion rates, duration of hospitalization, and complications were collected. Nineteen patients (12 girls and seven boys) between the ages of 1.2 and 5 months of age were treated with the endoscope-assisted technique. The mean operative time was 97 minutes. Five (26%) of 19 children received a blood transfusion. Most patients were discharged home the morning after surgery. The clinical courses of two patients who required additional major craniofacial reconstructions are discussed. There were no deaths, dural sinus tears, cerebrospinal fluid leaks, neurological injuries, or infections, and there were no complications related to the use of helmet therapy. Seventeen of the 19 patients achieved excellent cosmetic results with a single surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>This small series supports larger experiences and indicates that early treatment of craniosynostosis with minimally invasive, endoscope-assisted techniques is safe; limits blood transfusion, hospital stay, and operative time; and represents a valuable alternative to the traditional calvarial reconstruction methods.</jats:p></jats:sec>

Pancraniosynostosis following endoscope-assisted strip craniectomy and helmet orthosis for sagittal suture craniosynostosis in a nonsyndromic patient

“…It is suggested that this strategy is associated with a reduction in blood loss and transfusions, duration of hospital stay, and cost, as compared with other calvarial remodeling procedures. 1,[6][7][8][9]11 These 6 cited studies include more than 350 patients. Of these patients, 5 had nonsyndromic fusion of new sutures following the initial surgery.…”

Odilon Marc Lannelongue (1840–1911) and strip craniectomy for craniosynostosis

“…While open correction produces excellent results, blood loss and a long surgical duration may lead to complications in the child. 15,22 More recently, newer endoscopic minimally invasive techniques have been described for the treatment of craniosynostosis with the aim to minimize blood loss during surgery. 18 Jimenez and Barone first described the endoscopically assisted craniectomy for craniosynostosis in 1998.…”

“…In endoscopic craniectomy, the operation is performed by small incisions in the skin and endoscopes are used to expose the different areas of the affected suture and perform cranial vault remodeling. 9,15 While the endoscopic techniques allow less blood loss, they are suited for infants. It is indeed interesting to note how the strip craniectomy first described by Lannelongue has evolved into the present-day techniques of cranial vault remodeling.…”

The clinical picture of nonsyndromic craniosynostosis in children

“…Тригоноцефалия встречается в 10% случаев [10,11], чаще (75-85%) у мальчиков [8]. Данный вид краниосино-стоза может иметь генетическую природу вследствие ано-малий хромосом 3, 9, 11 и сочетаться с другими аномалия-ми развития нервной системы [12,13].…”