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Open access

Phuong D. Nguyen, Ahmed Belal, George N. Washington, Matthew R. Greives, David I. Sandberg, Stephen A. Fletcher, and Manish N. Shah

Unicoronal craniosynostosis correction with fronto-orbital advancement and cranial vault remodeling has traditionally been the gold standard. Distraction osteogenesis has the advantage of increased size of movement without constriction of the scalp and decreased morbidity. Although fronto-orbital advancement and cranial vault remodeling are usually performed at 6 months of age or later, distraction osteogenesis is performed at a younger age, between 3 and 6 months, to take advantage of the infant bony physiology. Herein, the authors demonstrate a case of distraction osteogenesis for unicoronal craniosynostosis in a 3-month-old female with significant improvement of her orbital, nasal, and frontal symmetry.

The video can be found here: https://vimeo.com/519047922

Open access

Michael M. McDowell, Robert Kellogg, Jesse A. Goldstein, and Taylor J. Abel

Endoscopic suturectomy combined with supplementary techniques such as spring-assisted expansion and cranial molding helmets for the correction of craniosynostosis is growing in popularity due to the reduced scar burdened, decreased morbidity, and reduced overall cost. The authors present their technique for the correction of isolated coronal craniosynostosis. The use of dedicated endoscopic tools and lit endoscopes permits enhanced visualization and technical ability, particularly at the distal portions of the suturectomy, and may reduce operative time and cerebrospinal fluid leak risk.

The video can be found here: https://vimeo.com/515401366.

Open access

Matthew D. Smyth and Kamlesh B. Patel

The craniofacial team at St. Louis Children's Hospital has been performing endoscopy-assisted synostosis surgery since 2006. Most infants with single-suture synostosis younger than 6 months of age are candidates. The sphinx position is used, with two incisions: one posterior to the bregma and one anterior to the lambda. The endoscope is incorporated primarily for epidural dissection and bone edge cauterization. Blood products are available but rarely needed with single suturectomies. Patients are managed on the floor after surgery and discharged to home on postoperative day 1, with helmet therapy coordinated and initiated immediately after surgery and continued until about 12 months of age.

The video can be found here: https://vimeo.com/513939623

Open access

Yasser Jeelani and Mark R. Proctor

Endoscopic surgery for single-suture synostosis has been widely adopted since its introduction over 2 decades ago. Its role in syndromic synostosis is emerging, both as a primary treatment and as the first stage in a multimodal treatment paradigm aimed at preventing the vexing turribrachycephaly seen in these children. In this video, the authors review the technique for endoscopic treatment of bilateral coronal craniosynostosis and discuss both the benefits and some of the concerns to look out for over time. They also review the long-term outcomes in a consecutive series of patients treated in this fashion.

The video can be found here: https://vimeo.com/516351348.

Open access

Robert M. Lober, Shobhan Vachhrajani, Salim Mancho, and Kambiz Kamian

The authors describe the use of the Gigli saw for craniectomy in minimal access surgery to address sagittal craniosynostosis. This modification allows for supine positioning and avoidance of potential brain compression with endoscopic instruments, and provides visually clear, safe, and facile removal of the fused suture and surrounding calvaria.

The video can be found here: https://vimeo.com/511568750.

Open access

Craig Birgfeld, Federico Di Rocco, Cormac O. Maher, Mark R. Proctor, and Matthew D. Smyth

Open access

David F. Jimenez

Lambdoid craniosynostosis leads to significant deformational changes of the calvaria and cranial fossae. Surgery used to treat the condition typically consists of a calvarial vault remodeling (CVR) procedure whereby the entire occiput is removed and reshaped along with a bandeau advancement to give the patient a rounded occiput. As an option, this video presents the minimally invasive endoscopic craniectomy used at the author's institution, which was developed there and has been successfully used for 25 years. This procedure is simple and can be done rapidly, with minimal to no blood loss. The video details the key steps necessary to successfully perform the procedure.

The video can be found here: https://vimeo.com/515746378.

Open access

Maria Licci, Pierre-Aurelien Beuriat, Alexandru Szathmari, Christian Paulus, Arnaud Gleizal, Carmine Mottolese, and Federico Di Rocco

Premature fusion of the metopic suture results in trigonocephaly with variable degrees of anterior cranial fossa dysmorphia and craniofacial deformity. Different surgical corrective techniques that aim to reshape the forehead and enlarge the cranial volume have been described. Typical variations of the standard fronto-orbitary advancement carry the risk of relevant blood loss during frontal osteotomy, where paired emissary metopic veins are disrupted. The authors present a technical variant that preserves a bony triangle over the glabella to optimize control of these veins, which represent the major source of bleeding, and applies Piezosurgery to perform the osteotomies to minimize bone substance loss.

The video can be found here: https://vimeo.com/511536423.

Open access

David S. Hersh, William A. Lambert, Markus J. Bookland, and Jonathan E. Martin

Surgical options for metopic craniosynostosis include the traditional open approach or a minimally invasive approach that typically involves an endoscopy-assisted strip craniectomy. The minimally invasive approach has been associated with less blood loss and operative time, a lower transfusion rate, and a shorter length of stay. Additionally, it is more cost-effective than open reconstruction, despite the need for a postoperative cranial orthosis and multiple follow-up visits. The authors describe a variation of the minimally invasive approach using a lighted retractor to perform a strip craniectomy of the metopic suture in a 2-month-old patient with metopic craniosynostosis.

The video can be found here: https://vimeo.com/511237503.

Open access

Masahiro Kameda, Eijiro Tokuyama, Takaya Senoo, and Isao Date

The multidirectional cranial distraction osteogenesis (MCDO) procedure, which uses an external distraction device, enables tailor-made distraction in an arbitrary direction, eliminating the disadvantage of unidirectional distraction with an internal distraction device. Multiple-suture synostosis cases for syndromic craniosynostosis patients are better indicated for this procedure. Here the authors describe seven cases in which the MCDO procedure was used to treat syndromic craniosynostosis. In each case, the MCDO procedure and postoperative distraction, with reference to midsagittal vector analysis of normal morphology in Japanese children, resulted in morphological improvement.

The video can be found here: https://vimeo.com/519006555