820 Endoscope-assisted Fronto-orbital and Cranial Osteotomies

Abstract

INTRODUCTION: An operative approach has been developed that incorporates fronto-orbital and cranial osteotomies to achieve immediate correction using specially designed bioresorbable plates and screws. Postoperative helmet/band therapy may be eliminated or its duration shortened using these techniques. METHODS: Forty-two patients (age, 2 to 8 mo) with sagittal (n = 25), metopic (n = 11), unicoronal (n = 5), or lambdoidal synostosis (n = 1) underwent endoscopic craniosynostosis repair with complex osteotomies performed through two or three small incisions in the scalp and/or upper eyelids. Suturectomy was performed in concert with wedge osteotomies, outfracture of parietal plates, reduction of cranial length, and stabilization with resorbable plates and screws for patients with sagittal synostosis, whereas unilateral or bilateral fronto-orbital advancement was performed for children with unilateral coronal (UCS) and metopic synostosis, respectively. Specially designed bioresorbable plates were used for fixation when appropriate. RESULTS: Follow-up has ranged from 1 month to 2 years. One patient developed bleeding in the recovery room that required transfusion. One patient with UCS required conversion to the open procedure. One patient with UCS will require reoperation. All patients were discharged by hospital Day 3. Two patients with sagittal synostosis had a small protrusion on the vertex of the cranium despite postoperative helmet therapy. Satisfactory to excellent aesthetic results were obtained in the remaining cases. In five of the children, helmets were not used. The others were placed in postoperative helmets for 6 to 12 weeks. CONCLUSION: Preliminary results are encouraging. More follow-up is necessary to determine selection criteria and critically evaluate outcomes. With more experience and refinement of instrumentation, minimally invasive repair will become an important tool in surgical management of craniosynostosis.