Early treatment of anterior calvarial craniosynostosis using endoscopic-assisted minimally invasive techniques

Abstract

Background: A total of 100 patients who presented with synostosis of the metopic or coronal suture were consecutively treated during a 6-year period using minimally invasive endoscopic-assisted suturectomies. After surgery, all patients were fitted with custom-made cranial helmets for up to 12 months.

Materials and methods: The coronal group consisted of 50 patients, 26 females and 23 males with a mean age of 3.78 months. Surgery was done through a single 2-mm incision at the ipsilateral stephanion. After endoscopic-assisted dissection, a craniectomy of the involved suture was done (mean width, 6 mm, and mean length, 10 cm). The metopic group consisted of 50 patients, 35 males and 16 females with a mean age of 4.1 months. A single 2- to 3-cm incision was placed on the midline behind the hairline. A suturectomy of the suture from anterior fontanelle to nasofrontal suture was performed (mean width, 7 mm, and mean length, 9.8 cm).

Results: For the entire cohort, the mean estimated blood loss was 34 cc (5-250 cc). The mean estimated percent of blood volume lost was 5.2% (1-26%). There were no intraoperative blood transfusions and five postoperative for a total transfusion rate of 6.7%. The mean surgical time was 56 min. All but one patient (99%) was discharged on the first postoperative day. Complications included two dural tears and four pseudomeningoceles. There were two cases of incomplete reossification of the craniectomy. There were no infections, mortalities, hematomas, or visual injuries. There were no complications related to helmet therapy except three superficial skin breakdowns that cleared immediately with helmet non-use for 3-4 days. Using anthropometric measurements and extensive photographic and physical assessments, excellent results were obtained in 84%, good results in 9%, and poor results in 7% of patients.

Conclusions: Early treatment of infants with coronal or metopic craniosynostosis using endoscopic assisted minimally invasive suturectomies is a safe and efficacious treatment alternative associated with excellent results in a large portion of these patients.