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Multiple-suture nonsyndromic craniosynostosis: early and effective management using endoscopic techniques
David F Jimenez1, Constance M Barone
1Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, Texas, USA. jimenezd3@uthscsa.edu
Insights
Minimally invasive endoscopic surgery effectively treats multiple-suture nonsyndromic craniosynostosis in infants. This technique, combined with cranial molding, corrects deformities safely with excellent outcomes.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Minimally Invasive Surgery
Background:
- Nonsyndromic craniosynostosis involving multiple sutures requires effective treatment strategies.
- Endoscopy-assisted techniques offer a less invasive approach compared to traditional open surgery.
Observation:
- A study evaluated 21 infants with multiple-suture nonsyndromic craniosynostosis treated with endoscopy-assisted craniectomies and postoperative cranial orthoses.
- The most frequently treated sutures were coronal, sagittal, metopic, and lambdoid.
Findings:
- Endoscopic treatment resulted in no deaths, with a mean follow-up of 61 months.
- Significant correction of deformities like brachycephaly, vertical dystopia, and nasal deviation was observed.
- Mean blood loss was 42 ml, mean hospital stay was 1 day, and the intraoperative transfusion rate was 0%.
Implications:
- Endoscopic techniques provide a safe and effective surgical alternative for complex craniosynostosis.
- Early intervention with this method leads to excellent correction of skull base and craniofacial abnormalities.
- This approach minimizes surgical trauma and hospital stay for pediatric patients.
Object:
The authors present the results of treating infants with multiple-suture nonsyndromic craniosynostosis in whom the authors used minimally invasive endoscopy-assisted techniques and postoperative cranial molding over an 11-year period.
Methods:
A total of 21 patients who presented with multiple-suture (nonsyndromic) craniosynostosis were treated using minimally invasive endoscopy-assisted craniectomies. Surgery was followed by treatment with custommade cranial orthoses for up to 12 months. A total of 48 sutures were treated. The most common was the coronal suture (38 cases) and this was followed by the sagittal (11 cases), metopic (6 cases), and lambdoid (3 cases) sutures. There were 13 male and 8 female pediatric patients. Their ages ranged between 3 weeks and 9 months (mean 3.2 months, median 2.5 months). The sagittal suture was treated with a wide vertex craniotomy via 2 incisions located behind the anterior fontanel and in front of the lambda. The metopic suture underwent a suturectomy as did the coronal and lambdoid sutures.
Results:
The mean follow-up duration was 61 months (range 3-135 months). There were no deaths. In patients with bicoronal synostosis, brachycephaly was corrected. Patients presenting with vertical dystopia or nasal deviation had these deformities corrected as well. The mean blood loss was 42 ml (range 10-120 ml). The mean hospital length of stay was 1 day. The intraoperative transfusion rate was 0%. The results indicate that nonsyndromic multiple-suture synostosis can be safely and effectively treated using endoscopic techniques.
Conclusions:
Early treatment of complex multiple-suture synostosis with endoscopic techniques provides an excellent surgical alternative. The results of the present study indicate marked correction of skull base and craniofacial deformities. Endoscopy provides a safe and effective way to treat these patients.
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