Endoscopy in Craniosynostosis Surgery: Evolution and Current Trends

Abstract

Over the past 30 years, advances in endoscopic technology and advancing interest in the benefits of minimally invasive approaches for craniofacial surgery have resulted in these techniques becoming a part of the standard of care in the treatment of craniosynostosis. In this review, we discuss the evolution and adoption of endoscopic-assisted strip craniectomy procedures. In addition to reviewing the studies describing various nuances and modifications to minimally invasive strip craniectomy, attention to comparisons in outcomes between traditional or open cranial vault reconstructions and endoscopic-assisted techniques is highlighted for different craniosynostosis diagnoses.

Keywords: Craniofacial; craniosynostosis; endoscope; endoscopic assisted; strip craniectomy; suturectomy.

Figure 1

Modified “sphinx” position for endoscopic-assisted sagittal suturectomy. The patient is placed in a slight reverse Trendelenburg position to minimize venous sinus pressure and thereby reduce potential blood loss

Figure 2

A burr hole made in the midline. Using high-speed drill and acorn-shaped drill bit, a burr hole can be placed at the midline. Because the shape of the acorn drill bit matched the midline keel, this technique helps minimize risks of dural injury when coming across the keel with a scissor or rongeur

Figure 3

Endoscopic-assisted strip craniectomy and bifrontal and biparietal wedge osteotomies for sagittal craniosynostosis. In addition to the sagittal suturectomy, triangular wedge-shaped osteotomies are performed bilaterally, posterior to the coronal suture and anterior to the lambdoid suture. The osteotomies are made down to the squamosal suture inferiorly to achieve biparietal widening

Figure 4

Immediate improvements in cranial index with wedge osteotomies. A–C: Preoperative top and lateral views. D–E: Immediate postoperative top views showing significant immediate biparietal widening. By extending the bifrontal and biparietal wedge osteotomy cuts down to or just beyond the squamosal suture, immediate improvement is noted in the CI and overall head shape due to the immediate biparietal widening

Figure 5

Endoscopic-assisted metopic suturectomy. A and B: Preoperative 3D reconstruction of the patient with metopic craniosynostosis. C–E: Postoperative 3D reconstruction. Metopic suturectomy performed from the anterior fontanelle to the level of the nasion. The frontal bones are contoured intraoperatively with a bone bender

Figure 6

Preoperative and postoperative images of infant with sagittal craniosynostosis who underwent endoscopic-assisted strip craniectomy with bifrontal and biparietal wedge osteotomies. A–C: Preoperative views of sagittal craniosynostosis at 1 month of age. D–E: Postoperative images 1 month after endoscopic-assisted sagittal suturectomy and wedge osteotomies. F–H: Postoperative images at 3-month follow-up