Early endoscopic release of craniosynostosis

By Mark Proctor, MD

The only technique available in the early days of surgical correction of craniosynostosis was the simple release of the fused suture via a large scalp incision. While effective in some children, this method had a high failure rate because the cranial bones would fuse back together before the brain was able to re- create the normal shape of the skull. Because of the failure of these release procedures, larger operations were adopted. The open-approach requires a large scalp incision; the bones are released physically, placed into a more normal position, and fixed (usually with resorbable plates). The success rates are high with this traditional open-method. Over the past two decades, advances in the field have incorporated some of the old techniques with some modern technologies. Drs. Jimenez and Barone developed a procedure whereby small incisions were used and an endoscope was inserted beneath the scalp to remove the fused suture. To avoid the early problem of bony re-fusion, this husband-wife team employed an orthotic molding helmet to reshape the head, thereby avoiding the failures seen in the early era of suture release. There are now almost 100 articles in the literature supporting the safety, and short- and long-term efficacy of this endoscopic technique. It can be used for all forms of single suture synostosis, as well as for bilateral coronal synostosis. The operation needs to be per- formed early, generally between 2 to 3 months of age, which differs from the larger open operations that are optimally performed closer to 8 to 12 months of age. Endoscopic release also requires the use of the helmet to reshape the skull, very similar to the helmets being used frequently for the correction of sleep-related cranial deformities in babies. The benefits of this technique include small incisions, minimal blood loss, and a much shorter hospital stay. The downsides include the need for the helmet, and more frequent follow-up in the 6 to 9 months following the operation for helmet adjustments and visits with the surgeon. In summary, the endoscopic approach to correction of craniosynostosis is an effective alternative to the open operations for families that wish to pursue it.