Multiple-suture nonsyndromic craniosynostosis: early and effective management using endoscopic techniques

Clinical article

Restricted access

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.

Abbreviation used in this paper: EBL = estimated blood loss.
Article Information

Contributor Notes

Address correspondence to: David F. Jimenez, M.D., Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MC 7843, San Antonio, Texas. email: jimenezd3@uthscsa.edu.
Headings
References
  • 1

    Barone CMJimenez DF: Endoscopic craniectomy for early correction of craniosynostosis. Plast Reconstr Surg 104:196519751999

  • 2

    Cartwright CCJimenez DFBarone CMBaker L: Endoscopic strip craniectomy: a minimally invasive treatment for early correction of craniosynostosis. J Neurosci Nurs 35:1301382003

    • Search Google Scholar
    • Export Citation
  • 3

    Jimenez DFBarone CM: Early treatment of anterior calvarial craniosynostosis using endoscopic-assisted minimally invasive techniques. Childs Nerv Syst 23:141114192007

    • Search Google Scholar
    • Export Citation
  • 4

    Jimenez DFBarone CM: Endoscopic approach to coronal craniosynostosis. Clin Plast Surg 31:415422vi2004

  • 5

    Jimenez DFBarone CM: Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg 88:77811998

  • 6

    Jimenez DFBarone CMEndoscopy-assisted craniectomies for the management of craniosynostosis. Jimenez DF: Intracranial Endoscopic Neurosurgery. Neurosurgical Topics Park Ridge, ILAmerican Association of Neurological Surgeons1998. 209220

    • Search Google Scholar
    • Export Citation
  • 7

    Jimenez DFBarone CM: Endoscopy-assisted wide-vertex craniectomy, “barrel-stave” osteotomies, and postoperative helmet molding therapy in the early management of sagittal suture craniosynostosis. Neurosurg Focus 9:3e22000

    • Search Google Scholar
    • Export Citation
  • 8

    Jimenez DFBarone CMMetopic synostosis. Rengachary SSBenzel EC: Calvarial and Dural Reconstruction. Neurosurgical Topics Park Ridge, ILAmerican Association of Neurological Surgeons1998. 135140

    • Search Google Scholar
    • Export Citation
  • 9

    Jimenez DFBarone CMCartwright CCBaker L: Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy. Pediatrics 110:971042002

    • Search Google Scholar
    • Export Citation
  • 10

    Jimenez DFBarone CMMcGee ME: Design and care of helmets in postoperative craniosynostosis patients: our personal approach. Clin Plast Surg 31:481487vii2004

    • Search Google Scholar
    • Export Citation
  • 11

    Jimenez DFBarone CMMcGee MECartwright CCBaker L: Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis. J Neurosurg 100:5 Suppl Pediatrics4074172004

    • Search Google Scholar
    • Export Citation
  • 12

    Johnson JOJimenez DFBarone CM: Blood loss after endoscopic strip craniectomy for craniosynostosis. J Neurosurg Anesthesiol 12:601999

    • Search Google Scholar
    • Export Citation
  • 13

    Johnson JOJimenez DFTobias JD: Anaesthetic care during minimally invasive neurosurgical procedures in infants and children. Paediatr Anaesth 12:4784882002

    • Search Google Scholar
    • Export Citation
  • 14

    Knoll BIShin JPersing JA: The bowstring canthal advancement: a new technique to correct the flattened supraorbital rim in unilateral coronal synostosis. J Craniofac Surg 16:4924972005

    • Search Google Scholar
    • Export Citation
  • 15

    Marchac D: Radical forehead remodeling for craniostenosis. Plast Reconstr Surg 61:8238351978

  • 16

    Marchac DRenier DBroumand S: Timing of treatment for craniosynostosis and facio-craniosynostosis: a 20-year experience. Br J Plast Surg 47:2112221994

    • Search Google Scholar
    • Export Citation
  • 17

    Marsh JLSchwartz HG: The surgical correction of coronal and metopic craniosynostoses. J Neurosurg 59:2452511983

  • 18

    Öcal ESun PPPersing JACraniosynostosis. Albright ALAdelson PDPollack IF: Principles and Practice of Pediatric Neurosurgery ed 2New YorkThieme2007. 265288

    • Search Google Scholar
    • Export Citation
  • 19

    Persing JBabler WWinn HRJane JRodeheaver G: Age as a critical factor in the success of surgical correction of craniosynostosis. J Neurosurg 54:6016061981

    • Search Google Scholar
    • Export Citation
  • 20

    Persing JAJane JADelashaw JB: Treatment of bilateral coronal synostosis in infancy: a holistic approach. J Neurosurg 72:1711751990

    • Search Google Scholar
    • Export Citation
  • 21

    Renier DBrunet IMarchac DIQ and craniostenosis: evolution in treated and untreated cases. Marchac D: Craniofacial Surgery BerlinSpringer-Verlag1987. 114117

    • Search Google Scholar
    • Export Citation
  • 22

    Tobias JDJohnson JOJimenez DFBarone CMMcBride DS Jr: Venous air embolism during endoscopic strip craniectomy for repair of craniosynostosis in infants. Anesthesiology 95:3403422001

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 253 239 16
Full Text Views 157 99 3
PDF Downloads 93 58 2
EPUB Downloads 0 0 0
PubMed
Google Scholar