Advantages of the double-incision approach in endoscopic management of unicoronal synostosis

Endoscopic strip craniectomy followed by postoperative helmet therapy has become a well-established treatment for single-suture craniosynostosis. Several incision patterns have been described in the medical literature. In this study, we describe a double-incision endoscopic strip craniectomy technique for unicoronal synostosis and discuss its technical pearls and potential advantages. Our endoscopic strip craniectomy technique for unicoronal synostosis uses two incisions. Patients typically present ipsilateral forehead flattening, contralateral frontal bossing, and harlequin eye deformity, with CT imaging confirming isolated premature fusion of one coronal suture. Endoscopic strip craniectomy is performed using two incisions (approximately 2 to 3 cm each) near the anterior fontanelle and the squamosal suture. A 1-cm-wide strip craniectomy is performed under endoscopic visualization, with additional barrel stave osteotomies performed under direct visualization. The temporalis muscle is elevated and resuspended using drill holes at the craniotomy edge. Patients are typically discharged on postoperative day 1. Helmet therapy is initiated 2 weeks postoperatively and continues for 9-12 months. Early follow-up demonstrates significant improvement in forehead and orbital symmetry, with well-healed incisions. Follow-up through 5 years of age demonstrates favorable cranial and facial contour with no significant residual deformity. Developmental and ophthalmologic evaluations remain within normal limits, and additional surgical intervention for craniosynostosis is not typically required. A double-incision endoscopic strip craniectomy technique optimizes surgical exposure while minimizing scar-related morbidity. This approach ensures extension of the craniectomy to the anterior fontanelle and the squamosal suture and facilitates barrel stave osteotomies and temporalis muscle resuspension.