Microscopic minimally invasive approach to nonsyndromic craniosynostosis.
OBJECTIVE
The purpose of this retrospective study was to present the results of the authors' microscopic minimally invasive approach in the treatment of nonsyndromic craniosynostosis.


METHODS
From 2001 to 2007, the authors treated a cohort of 67 infants with nonsyndromic sagittal, unicoronal, bicoronal, and metopic craniosynostosis, either with the microscopic (n = 40) or the open (n = 27) approach. In the microscopic approach, incisions were placed over the premature suture, and using a surgical microscope, the appropriate synostectomy was performed. The open approach used a traditional coronal incision with cranial vault reconstruction. Both groups of patients had postoperative molding helmet therapy. Finally, anthropometric measurements were used to evaluate the treatment results. The measurement used for the patients with sagittal and bicoronal craniosynostoses was the divergence from the norm of the age-adjusted cephalic index. The (FZr-EUl/FZl-EUr) and (FZr-EUr)/(FZl-EUl) were used for the patients with unicoronal craniosynostosis. The divergence from the norm of age-adjusted (FTr-FTl)/(Tr-Tl) was used for the patients with metopic craniosynostosis. (FZr = right frontozygomaticus, EUl = left eurion, FZl = left frontozygomaticus, Eur = right eurion, FTr = right frontotemporale, FTl = left frontotemporale, Tr = tragion, Tl = left tragion).


RESULTS
The median surgical times for microscopic and open approaches were 108 and 210 minutes, the volumes of blood loss were 75 and 220 mL, the durations of hospital stay were 2 and 4 days, the numbers of helmet were 2 and 1, and the durations of helmet therapy were 10.5 and 8 weeks, respectively. The analysis of variance for repeated measures showed that there was no statistically significant difference between the 2 groups in any of the craniosynostoses.


CONCLUSIONS
The treatment outcomes from the microscopic minimally invasive approach to craniosynostosis are equal to those seen with the open approach. The microscopic approach results in less operative time, blood loss, and hospitalization.
Teichgraeber
John F
JF
Division of Pediatric Plastic Surgery, Department of Pediatric Surgery and Orthodontics, University of Texas Health Science Center at Houston, TX, USA.
Baumgartner
James E
JE
Waller
Amy L
AL
Reis
Scott M
SM
Stafford
Marshall T
MT
Hollinger
Laura E
LE
Gateno
Jaime
J
Xia
James J
JJ
D016063:Blood Loss, Surgical; D002508:Cephalometry / Q000379:methods; D015331:Cohort Studies; D003393:Cranial Sutures / Q000002:abnormalities / Q000601:surgery; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000002:abnormalities / Q000601:surgery; D006260:Head Protective Devices; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008866:Microsurgery / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009989:Orthotic Devices; D010294:Parietal Bone / Q000002:abnormalities / Q000601:surgery; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome