Endoscopic Repair of Sagittal Craniosynostosis - An Evolution in Care
Albert S. Woo, MD, Dennis C. Nguyen, MD, Gary B. Skolnick, BS, Sybill D. Naidoo, PhD, RN, CPNP, Brian Dlouhy, MD, Kamlesh B. Patel, MD, Matthew D. Smyth, MD.
Washington University, St. Louis, St. Louis, MO, USA.
PURPOSE: We examine our first 100 endoscopic-assisted repairs of sagittal craniosynostosis and review the evolution of patient care protocols.
METHODS: Retrospective chart review was performed of our first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006-2014. Perioperative, clinical outcomes and complication data were analyzed. Measurements were taken from pre-operative and 1-year post-operative CT scans.
RESULTS: Average age at surgery was 3.3±1.1 months (range: 1.6-6.9 months). There were 30 females and 70 males. The following perioperative data (average±SD) were noted: operative time (77.1±22.2 minutes); estimated blood loss (34.0±34.8 cc); length of stay (1.1±0.4 days); transfusion rate (9%); pre-operative cephalic index (CI) (69.1±3.8), post-operative CI (77.7±4.2). One patient required conversion to open technique due to presence of a large emissary vein that was difficult to control endoscopically. Helmets were prepared by the orthotists preoperatively so that therapy could begin between postoperative days 1-3. Average duration of helmet therapy was 8.0±2.9 months.
CONCLUSION: Outcomes seen in our population are similar to those seen at other high-volume centers. The immediate benefits of the endoscopic technique have been well-described: shorter operating times, decreased length of stay, reduced transfusion rate, and lower overall cost than open procedures. Three-year follow-up revealed that endoscopic repair remains equivalent to open repair and age-matched controls (i.e., CI, cranial vault volume and height, and forehead inclination). We have been able to remove less bone using our “narrow-strip” suturectomy technique without affecting safety or outcome. Early initiation of helmet therapy and collaborative care with orthotists remain the most essential aspects of successful outcome.
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