Endoscopic craniosynostosis repair

Abstract

Introduction: Craniosynostosis is a rare condition that affects approximately one child in every 2,000 live births, and involves pathological fusion of two or more skull bones. Consequences of craniosynostosis include possible limitation of brain growth and cosmetic effects on the appearance of the child. Traditional repairs for these conditions over the past 3-4 decades have involved an open operation with a large skin incision and major manipulations of the skull bones. More recently, minimally invasive endoscopic techniques have been developed to release the skull bones, followed by postoperative treatment with either an external orthosis or internal springs and distractors to achieve the desired correction.

Methods: In this review minimally invasive endoscopic repair will be reviewed. A general overview of the condition and techniques for correction will be discussed, followed by specific application of these surgeries for different craniosynostosis diagnoses. Attention to the subtleties of each specific condition will be highlighted.

Summary: Over the past two decades clinical experience and a large number of publications have substantiated the benefits of minimally invasive endoscopic techniques for the treatment of craniosynostosis. These techniques have clear benefits for selected patients, and should be part of the standard of care for this condition at craniofacial centers.

Keywords: Craniosynostosis; endoscopic; plagiocephaly.

Figure 1

Diagram of normal skull anatomy and major forms of skull deformity.

Figure 2

3D laser image of sagittal synostosis before and after surgery and helmet therapy.

Figure 3

3D laser image of metopic synostosis before and at two time points after surgery, showing gradual progression of improvement.

Figure 4

3D laser scan image of left coronal unicoronal craniosynostosis before and after laser helmet therapy.