Management of midline craniosynostosis using endoscopic techniques

A total of 260 patients presenting with midline craniosynostosis were treated over a ten year period (1998-2008) using endoscopic assisted minimally invasive techniques and postoperative cranial orthotic therapy. There were 187 patients with sagittal synostosis and 73 with metopic synostosis. In the sagittal group, there were 137 males (74%) and 50 females (26%). The mean age was 3.7 months and median 3.25 months. Surgery consisted of wide vertex craniectomy and bilateral barrel stave osteotomies. The mean blood loss was 27 cc's, the transfusion rate was 1% and only 2 patients received blood intraoperatively. Using anthropometric cephalic index, photographs and long term follow-up, the results included 87% excellent, 8.7% good and 4.3% poor. The series mortality rate was 1% (n=2). In the metopic group, there were 50 males (68%) and 23 females (32%). The mean age was 4.25 months and median age 4.5 months. Surgery consisted of resection of the stenosed metopic suture from the anterior fontanelle to the nasofrontal suture. The mean width of the craniectomy was 6 mm. The mean blood loss was 15 cc's, the transfusion rate was 1.3% with only one patient receiving an intraoperative blood transfusion. Hypotelorism. was corrected in all cases and trigonocephalic head shape fully corrected in 32%. Mortality rate was zero. In summary, the use of minimally invasive endoscopic techniques to treat midline craniosynostosis in infants is a safe, efficacious and practical way of treating patients with these conditions.