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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>In 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Two 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 &lt; 1 year to 13.4 years). Six children (&lt; 3%) had subsequent open procedures for perceived suboptimal aesthetic results, 4 of whom (&gt; 66%) had either coronal or metopic craniosynostosis. No patient in this series either presented with or subsequently developed signs or symptoms of intracranial hypertension.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In 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.</jats:p></jats:sec>

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

“…In line with our colleagues [ 11 , 27 , 41 ], we consider patients 3 months of age as ideal patients for EACS followed by helmet therapy. Although the results seem to be less ideal for older children, decisions are formed individually and caregivers should be informed about the possible surgical options and expected outcome and take the decision.…”

“…In particular, this leads to a diverging presentation of the according data analyzing multiple different aspects. As often stated over the past years [ 1 , 11 , 19 , 27 , 45 ], this heterogeneity constitutes a major problem in terms of comparability between different strategies.…”

“…Among them, four indicated to do so in all patients [ 28 , 34 , 37 , 44 ], whereby only one [ 22 ] preserved the confirming method for cases of observed papilledema or macrocephaly [ 22 ]. Other teams elaborated their anthropometric measurements by caliper [ 25 , 39 , 44 ], either using existing 3D reconstructed CT scans [ 34 , 37 , 44 ], laser scans evaluated by the orthotist [ 2 , 11 , 25 , 33 , 35 , 42 , 48 ], or their results on 3D images taken photographically [ 39 ]. The most common anthropometric measurement tool used in our included data was the CI (cranial index, defined by BP/AP diameter × 100).…”

“…While cranial vault remodeling through large skin incisions has been used and evolved for decades [ 19 , 36 ], the endoscopic techniques were introduced more recently in the early 1990s by Jimenez and Barone [ 27 ]. Endoscopy-assisted suturectomies have proven to result in cosmetic outcomes similar to those achieved by open approaches [ 2 , 5 , 12 , 17 , 18 , 20 – 22 , 29 ], whereas the published data suggests that operating room times, length of hospital stay, and rates of blood transfusions were reduced [ 10 , 11 , 13 , 15 , 49 ]. Sagittal suture synostosis, depicting the most common form of craniosynostosis, accounts for 40–60% of all single suture synostosis [ 26 ].…”

Paradigm Shift in Materials for Skull Reconstruction Facilitated by Science and Technological Integration

“…Using a 3D digital printing model for cranial surgery to achieve the desired shape, a computer-aided design system and direct computer-aided manufacture are employed in the pre-operative production (i.e., prefabrication) of a cranioplasty prosthesis. This approach makes use of commonly available 3D CT data [ 32 ]. The cranial defect boundary can be seen on a 3D head CT-scan image of the skull surface.…”