Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience

Shah, Manish N.; Kane, Alex A.; Petersen, J. Dayne; Woo, Albert S.; Naidoo, Sybill D.; Smyth, Matthew D.

doi:10.3171/2011.5.peds1128

Cited by 147 publications

(152 citation statements)

References 34 publications

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“…In broad terms, these approaches appear to result in better morphological outcomes than open vertex strip craniectomy procedures, with cephalic indices within the normal range. 7,10,18,30,37,41 If the correction of the scaphocephalic deformity is an important determinant of the development of raised ICP, then one might expect these techniques to have a similar postoperative incidence to that we report for CR. However, we do not understand the mechanism by which intracranial hypertension arises in SC following surgery.…”

Section: Discussionmentioning

confidence: 77%

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The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

Thomas

Johnson

Byren

et al. 2015

PED

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OBJECT Raised intracranial pressure (ICP) is recognized to occur in patients with nonsyndromic isolated sagittal craniosynostosis (SC) prior to surgery. However, the incidence of raised ICP following primary surgery is rarely reported and there appears to be a widely held assumption that corrective surgery for SC prevents the later development of intracranial hypertension. This study reports the incidence of postoperative raised ICP in a large cohort of patients with SC treated by 1 of 2 surgical procedures in a single craniofacial unit. METHODS A retrospective review was performed of all patients with SC who underwent either a modified strip craniectomy (MSC) or calvarial remodeling (CR) procedure under the care of the Oxford Craniofacial Unit between 1995 and 2010 and who were followed up for more than 2 years. The influence of patient age at surgery, year of surgery, sex, procedure type, and the presence of raised ICP preoperatively were analyzed. RESULTS Two hundred seventeen children had primary surgery for SC and were followed up for a mean of 86 months. The overall rate of raised ICP following surgery was 6.9%, occurring at a mean of 51 months after the primary surgical procedure. Raised ICP was significantly more common in those patients treated by MSC (13 of 89 patients, 14.6%) than CR (2 of 128 patients, 1.6%). Also, raised ICP was more common in patients under 1 year of age, the majority of whom were treated by MCS. No other factor was found to have a significant effect. CONCLUSIONS Postoperative raised ICP was found in more than 1 in 20 children treated for nonsyndromic SC in this series. It was significantly influenced by the primary surgical procedure and age at primary surgery. Careful long-term follow-up is essential if children who develop raised ICP following surgery are not to be overlooked.

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Section: Discussionmentioning

confidence: 77%

“…7,10,17,18,30,37,41,48,52 The incidence of postoperative intracranial hypertension with these procedures has yet to be reported. In broad terms, these approaches appear to result in better morphological outcomes than open vertex strip craniectomy procedures, with cephalic indices within the normal range.…”

Section: Discussionmentioning

confidence: 99%

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

Thomas

Johnson

Byren

et al. 2015

PED

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“…In 2011, Shah et al concluded that endoscope-assisted strip craniectomy offers an effective treatment for sagittal craniosynostosis that is comparable for calvarial vault reconstruction, with no increase in morbidity. 24 The patients treated with endoscopic technique (n = 47) had significantly shorter hospital stay, less blood loss, lower transfusion rates, shorter operating times, and equivalent postoperative CIs (endoscopic 75.9, open 76.9) compared with patients who underwent open surgery (n = 42). The patients in the endoscopic group had been followed for 13 months, while those in the open group were followed for 24.6 months.…”

Section: Discussionmentioning

confidence: 99%

One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

Nguyen

Farber

Skolnick

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEEndoscope-assisted repair of sagittal craniosynostosis was adopted at St. Louis Children’s Hospital in 2006. This study examines the first 100 cases and reviews the outcomes and evolution of patient care protocols at our institution.METHODSThe authors performed a retrospective chart review of the first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006 and 2014. The data associated with length of hospital stay, blood loss, transfusion rates, operative times, cephalic indices (CIs), complications, and cranial remolding orthosis were reviewed. Measurements were taken from available preoperative and 1-year postoperative 3D reconstructed CT scans.RESULTSThe patients’ mean age at surgery was 3.3 ± 1.1 months. Of the 100 patients, 30 were female and 70 were male. The following perioperative data were noted. The mean operative time (± SD) was 77.1 ± 22.2 minutes, the mean estimated blood loss was 34.0 ± 34.8 ml, and the mean length of stay was 1.1 ± 0.4 days; 9% of patients required transfusions; and the mean pre- and postoperative CI values were 69.1 ± 3.8 and 77.7 ± 4.2, respectively. Conversion to open technique was required in 1 case due to presence of a large emissary vein that was difficult to control endoscopically. The mean duration of helmet therapy was 8.0 ± 2.9 months. Parietal osteotomies were eventually excluded from the procedure.CONCLUSIONSThe clinical outcomes and improvements in CI seen in our population are similar to those seen at other high-volume centers. Since the inception of endoscope-assisted repair at our institution, the patient care protocol has undergone several significant changes. We have been able to remove less cranium using our “narrow-vertex” suturectomy technique without affecting patient safety or outcome. Patient compliance with helmet therapy and collaborative care with the orthotists remain the most essential aspects of a successful outcome.

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“…20 Recent surgical advances 13 have led to improvements in and thus a focus on minimally invasive therapeutic strategies 5 in infants affected with various forms of craniosynostosis. 19,24 First pioneered by Jimenez and Bar-A comparison of costs associated with endoscope-assisted craniectomy versus open cranial vault repair for infants with sagittal synostosis one, 12 endoscope-assisted craniectomy (EAC) performed in the first 6 months of life 11 has helped to decrease operative time, 26 blood loss, 18 transfusion requirements, 9 and hospital stays.…”

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confidence: 99%

A comparison of costs associated with endoscope-assisted craniectomy versus open cranial vault repair for infants with sagittal synostosis

Vogel¹,

Woo

Kane

et al. 2014

PED

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Object The surgical management of infants with sagittal synostosis has traditionally relied on open cranial vault remodeling (CVR) techniques; however, minimally invasive technologies, including endoscope-assisted craniectomy (EAC) repair followed by helmet therapy (HT, EAC+HT), is increasingly used to treat various forms of craniosynostosis during the 1st year of life. In this study the authors determined the costs associated with EAC+HT in comparison with those for CVR. Methods The authors performed a retrospective case-control analysis of 21 children who had undergone CVR and 21 who had undergone EAC+HT. Eligibility criteria included an age less than 1 year and at least 1 year of clinical follow-up data. Financial and clinical records were reviewed for data related to length of hospital stay and transfusion rates as well as costs associated with physician, hospital, and outpatient clinic visits. Results The average age of patients who underwent CVR was 6.8 months compared with 3.1 months for those who underwent EAC+HT. Patients who underwent EAC+HT most often required the use of 2 helmets (76.5%), infrequently required a third helmet (13.3%), and averaged 1.8 clinic visits in the first 90 days after surgery. Endoscope-assisted craniectomy plus HT was associated with shorter hospital stays (mean 1.10 vs 4.67 days for CVR, p < 0.0001), a decreased rate of blood transfusions (9.5% vs 100% for CVR, p < 0.0001), and a decreased operative time (81.1 vs 165.8 minutes for CVR, p < 0.0001). The overall cost of EAC+HT, accounting for hospital charges, professional and helmet fees, and clinic visits, was also lower than that of CVR ($37,255.99 vs $56,990.46, respectively, p < 0.0001). Conclusions Endoscope-assisted craniectomy plus HT is a less costly surgical option for patients than CVR. In addition, EAC+HT was associated with a lower utilization of perioperative resources. Theses findings suggest that EAC+HT for infants with sagittal synostosis may be a cost-effective first-line surgical option.

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Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience

Cited by 147 publications

References 34 publications

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

A comparison of costs associated with endoscope-assisted craniectomy versus open cranial vault repair for infants with sagittal synostosis

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