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Published on: July 5, 2021
Early endoscopy-assisted treatment of multiple-suture craniosynostosis
Mónica Rivero-Garvía1, Javier Marquez-Rivas, Ana Belén Rueda-Torres
1Unit of Pediatric Neurosurgery, Department of Neurosurgery, Virgen del Rocío University Hospital, Seville, Spain. monicargarvia@msn.com
Insights
Endoscopy-assisted craniosynostosis repair is safe and effective in infants under 4 months. Early intervention with this minimally invasive technique may prevent complications like ventriculomegaly and Chiari I malformation.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Craniosynostosis, premature fusion of skull sutures, requires timely intervention.
- Endoscopy-assisted techniques offer a minimally invasive approach to cranial vault remodeling.
- Management of complex craniosynostosis in very young infants presents unique challenges.
Purpose of the Study:
- To evaluate the safety and benefits of endoscopy-assisted craniosynostosis treatment in infants under 4 months.
- To assess the efficacy of early surgical intervention for complex craniosynostosis.
- To determine the incidence of complications and long-term outcomes in this patient cohort.
Main Methods:
- Retrospective analysis of infants under 4 months with multiple-suture craniosynostosis treated with endoscopy-assisted cranial remodeling.
- Data collected included patient demographics, diagnosis, age at treatment, surgical details, hospital stay, and follow-up outcomes.
- Clinical and radiological assessments were performed to evaluate surgical results and complications.
Main Results:
- Seven infants under 4 months underwent the procedure, with diagnoses including syndromic and nonsyndromic craniosynostosis.
- Mean age at treatment was 62.8 days; mean hospital stay was 2.3 days.
- No procedure-related complications occurred, and no patients developed ventriculomegaly or Chiari I malformation. Good aesthetic outcomes were noted.
Conclusions:
- Endoscopy-assisted surgery is a safe and effective treatment for craniosynostosis in infants under 4 months.
- Early intervention using this technique may prevent the development of associated neurological complications.
- This approach provides a valid management option for complex craniosynostosis in the earlyinfancy period.
Aims:
Endoscopy-assisted treatment of craniosynostosis constitutes a novel modality for management of complex craniosynostoses. In this work, the authors aimed to assess the safety and advantages of performing these techniques in patients under 4 months of age.
Patients And Methods:
Our study group comprised patients aged 4 months or younger with multiple-suture craniosynostosis undergoing endoscopy-assisted cranial remodeling.
Results:
Between March 2007 and June 2011, we treated seven patients with combined affected sutures, five with unclassified nonsyndromic craniosynostosis, one with Muenke's and another with Crouzon's syndromes. One child with a cloverleaf skull had a family history of craniosynostosis. Mean age at diagnosis was 35.3 days (1-90 days). The most frequent combinations of involved sutures were sagittal and bicoronal suture (n = 3) and bilateral coronal suture (n = 3). Mean age at treatment was 62.8 days (13-109 days). Blood transfusion was required in only two patients. The mean length of hospital stay was 2.3 days (2-4 days). Mean follow-up period was 20.14 months (7-46 months). No patient presented ventriculomegaly or Chiari I malformation in follow-up studies, and only one showed a vertical disposition of the posterior fossa. No patient presented complications related to the procedures. A good result (Barlett I) was observed at 3- and 6-month follow-up visits. Four patients followed up for more than 1 year did not develop craniolacunae.
Conclusion:
Endoscopy-assisted surgery for correction of craniosynostosis in children under 4 months represents a valid and safe management option. Early treatment may contribute to prevent the development of associated ventriculomegaly and Chiari I malformation.
