Endoscopic-assisted repair of craniosynostosis

Abstract

Object The goal of the craniofacial surgeon has always been the correction of form and function with prevention of associated morbidity and death. Through the pioneering work of Jimenez and Barone, minimally invasive approaches to the surgical correction of craniosynostosis are now gaining wider acceptance. Here the authors review the technique for endoscopic-assisted repair of craniosynostosis from the perspective of a new minimally invasive approach. They also assess the safety, efficacy, and results of the early treatment of infants with craniosynostosis in a small series of children who underwent surgery at this institution. Methods Data regarding synostosis type, operative time, patient age, blood loss, transfusion rates, duration of hospitalization, and complications were collected. Nineteen patients (12 girls and seven boys) between the ages of 1.2 and 5 months of age were treated with the endoscope-assisted technique. The mean operative time was 97 minutes. Five (26%) of 19 children received a blood transfusion. Most patients were discharged home the morning after surgery. The clinical courses of two patients who required additional major craniofacial reconstructions are discussed. There were no deaths, dural sinus tears, cerebrospinal fluid leaks, neurological injuries, or infections, and there were no complications related to the use of helmet therapy. Seventeen of the 19 patients achieved excellent cosmetic results with a single surgery. Conclusions This small series supports larger experiences and indicates that early treatment of craniosynostosis with minimally invasive, endoscope-assisted techniques is safe; limits blood transfusion, hospital stay, and operative time; and represents a valuable alternative to the traditional calvarial reconstruction methods.