Endoscopic-assisted calvarial vault remodeling without postoperative helmets for treating infants with sagittal synostosis

Abstract

Objective: Various endoscopically assisted minimally invasive surgical procedures have been described for the management of isolated nonsyndromic sagittal synostosis. All these techniques necessitate the use of postoperative helmets without immediate correction of the head shape. Here, we document the safety and sustainable acceptable outcomes of an endoscopic minimally invasive approach with full barrel staving without using a postoperative cranial helmet. Methods: A single-institution cohort analysis was performed on five patients who underwent endoscopically assisted minimally invasive calvarial vault remodeling without using a postoperative helmet for isolated nonsyndromic sagittal synostosis between 2017 and 2022. Variables analyzed were age at the time of surgery, gender, Estimated Blood Loss (EBL), operative time, postoperative complications, and pre-and postoperative Cephalic Index (CI). Results: Three male and two female infants were treated at our hospital in 2017–2022 with a mean follow-up of 32.6 months. At the time of the surgery, the mean age was ±3.5 months (range 10–58 months), the mean weight was 4.54 kg (standard deviation, SD ± 1.56), the mean EBL was 34.6 ml (range 20 ml – 54 ml) and mean surgical time from skin incision to dressing application was 120.7 min. The mean CI for all patients was 66.88 ± 4 (SD) preoperatively vs. 81.52 ± 2.38 (SD) postoperatively (p < 0.001 by paired Student’s t - test). There were no deaths or intraoperative complications. Conclusions: We present a novel endoscopically assisted minimally invasive procedure without using a postoperative helmet. This was a safe and efficacious procedure for isolated sagittal craniosynostosis, with improvements in CI at a mean follow-up of 32.6 months.