Endoscopic Release of Unicoronal Craniosynostosis

Abstract

We demonstrate a novel method of endoscopic frontal-orbital advancement for the treatment of unicoronal craniosynostosis. The evolution of this cranioplasty modality burrows from an established precedent of safety and technical experience in strip craniectomies and endoscopic brow surgery. The procedure facilitates osteotomies similar to open frontal-orbital advancement and uses reabsorbable materials to achieve immediate intraoperative correction of unicoronal craniosynostosis through smaller incisions. The patients in the study underwent endoscopic frontal-orbital advancement and cranial vault remodeling. This was made possible with the use of a novel ultrasonic bone saw that permits osteotomies to be made with minimal disruption to the dura matter. After full frontal-orbital advancement, immediate reabsorbable fixation was used to stabilize the advancement as in the open technique. There were no major complications. All patients demonstrated improvement in plagiocephaly due to unilateral coronal synostosis. Patients and their families reported a 100% patient satisfaction and an improvement in cranial asymmetry from 10 to 2 mm (P < 0.5). This is a new endoscopic cranial vault remolding technique that achieves state-of-the-art correction of unicoronal craniosynostosis with less morbidity and mortality.

A Critical Evaluation of Long-Term Aesthetic Outcomes of Fronto-Orbital Advancement and Cranial Vault Remodeling in Nonsyndromic Unicoronal Craniosynostosis

“…4 The literature is replete with varied techniques for bony correction, [1][2][3][4][5][6][7][8][9][10][11][12] and although an exhaustive description of those techniques is outside the scope of this study, most involve creation and repositioning of the supraorbital bandeau unilaterally or bilaterally, remodeling of the anterior cranial vault, and fixation. [1][2][3][4][5][6][7][8][9][10][11][12] Despite technical improvements over the past four decades, few long-term studies have rigorously assessed the aesthetic outcomes associated with correction of the unilateral coronal synostosis deformity. Indeed, different authors have cited a wide range of complication, reoperation, and recurrence rates.…”

Plagiocephaly due to Frontosphenoidal Suture Synostosis: Report of 2 Cases and Literature Review

“…A promising technique which has been already used for coronal synostosis, but not yet in frontosphenoidal synostosis, is endoscopic-assisted suturectomy [16,17]. Preliminary results indicate that it is associated with less morbidity and mortality compared to the conventional bilateral orbital advancement, but further studies encompassing a large number of cases, including cases of frontosphenoidal synostosis, are necessary.…”

Photometric evaluation of cranial and facial symmetry in hemicoronal single suture synostosis treated with surgical fronto-orbital remodeling

“…Since the late 1960s, when Paul Tessier described surgical cranioplasty with the preparation of a frontal bone segment and fronto-orbital bandeau, several alternatives were proposed: variations of the osteotomy design (Guzman et al, 2011), the application of distractors (Taylor et al, 2014; or springs , and endoscopic techniques with post-surgical helmets (Sauerhammer et al, 2014;Stelnicki et al, 2009). Part of the re-expression of the phenotype may be due to inadequate procedures .…”