Flexible endoscope–assisted suture release and barrel stave osteotomy for the correction of sagittal synostosis

Jason LabuschagneDepartment of Neurosurgery, University of the Witwatersrand, Johannesburg;
Department of Pediatric Neurosurgery, Nelson Mandela Children’s Hospital, Johannesburg, South Africa; and

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Denis MutyabaDepartment of Neurosurgery, University of the Witwatersrand, Johannesburg;
Department of Pediatric Neurosurgery, Nelson Mandela Children’s Hospital, Johannesburg, South Africa; and

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John OumaDepartment of Neurosurgery, University of the Witwatersrand, Johannesburg;

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Michael C. DewanDepartment of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee

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OBJECTIVE

Early suturectomy with a rigid endoscope followed by orthotic cranial helmet therapy is an accepted treatment option for single-suture craniosynostosis. To the authors’ knowledge, flexible endoscope–assisted suture release (FEASR) has not been previously described. Presented herein is their experience with FEASR for the treatment of isolated sagittal craniosynostosis.

METHODS

A retrospective analysis of the health records of patients who had undergone FEASR between March 2018 and December 2020 was performed. Patients under the age of 6 months who had been diagnosed with isolated sagittal synostosis were considered eligible for FEASR. Exclusion criteria included syndromic synostosis or multiple-suture synostosis. The cephalic index, the primary measure of the cosmetic endpoint, was calculated at prespecified intervals: immediately preoperatively and 6 weeks and 12 months postoperatively. Parental satisfaction with the cosmetic outcome was determined throughout the clinical follow-up and documented according to a structured questionnaire for the first 12 months.

RESULTS

A total of 18 consecutive patients met the criteria for study inclusion. The mean patient age at the time of surgery was 3.4 months (range 2–6 months). All patients underwent a wide craniectomy with no need to convert to an open procedure. The mean craniectomy width was 3.61 cm. Estimated blood loss ranged from 5 to 30 ml. The mean operative time was 75 minutes. No intraoperative complications were observed. The average length of stay was 2.6 days. The mean cephalic index was 67.7 preoperatively, 77.1 at 6 weeks postoperatively, and 76.3 at 1 year postoperatively. The mean percentage change in the cephalic index from preoperatively to the 12-month follow-up was 10.44 (p < 0.001). The mean follow-up was 17 months (range 12–28 months). All parents were satisfied with the cosmetic outcome of the procedure. No patients developed symptoms of raised intracranial pressure (ICP) or needed invasive ICP monitoring during the follow-up period. No patients required reoperation.

CONCLUSIONS

In this modest single-hospital series, the authors demonstrated the feasibility of FEASR in treating sagittal synostosis with favorable cosmetic outcomes. The morbidity profile and resource utilization of the procedure appear similar to those of procedures conducted via traditional rigid endoscopy.

ABBREVIATIONS

FEASR = flexible endoscope–assisted suture release ; ICP = intracranial pressure ; LMICs = low- and middle-income countries ; LOS = length of stay.
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Figure from Candela-Cantó et al. (pp 61–70).

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