title: Endoscopic-assisted correction of metopic synostosis.
abstract: Our 6-year experience with correction of metopic synostosis using a minimally invasive endoscopic-assisted technique followed by postoperative cranial vault helmet molding is presented. In addition, a simple, objective method for quantification of the frontal vault contour is described.A total of 16 patients, 13 males and 3 females, with nonsyndromic, single-suture synostosis were included in the study. Patient age at operation averaged 2.9 months and the mean weight was 6 kg. The mean operative time was 79 minutes. The estimated blood loss during the procedure was 82.8 mL. Three patients required blood transfusions (18.7%). There were no significant postoperative complications. The mean hospitalization was 1.6 days. The average surgical cost, including the helmets, was $12,400, in contrast to $33,000 charged for the equivalent open procedure.Very good esthetic results, judged by physical examination and photograph comparison, were obtained in all patients. No relapses were noted. Objectively, the outcome of the operative repair was evaluated using laser scanning. For quantification of the distortion and the postoperative level of correction, the metopic angle was defined and used. This angle changed from preoperative value of 104.9 degrees to 111.3 degrees at 3 months (P = 1.59E-06) and to 114.9 degrees at 1 year postoperatively (P = 2.51E-09).Due to its promising attributes, minimally invasive strip craniectomy emerges as an ideal modality for correction of metopic synostosis. Furthermore, the metopic angle should provide clinicians with an objective measure of the frontal cranial vault deformity and its correction.
authors.affiliation: Division of Plastic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA. barbu.gociman@hsc.utah.edu
authors.forename: Barbu
authors.initials: B
authors.lastname: Gociman
authors.forename: Mouchammed
authors.initials: M
authors.lastname: Agko
authors.forename: Ross
authors.initials: R
authors.lastname: Blagg
authors.forename: Jared
authors.initials: J
authors.lastname: Garlick
authors.forename: John R W
authors.initials: JR
authors.lastname: Kestle
authors.forename: Faizi
authors.initials: F
authors.lastname: Siddiqi
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D002508:Cephalometry / Q000379:methods; D003393:Cranial Sutures / Q000601:surgery; D003398:Craniosynostoses / Q000191:economics / Q000601:surgery*; D003399:Craniotomy / Q000191:economics / Q000379:methods; D004724:Endoscopy / Q000191:economics / Q000379:methods*; D017707:Erythrocyte Transfusion; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000601:surgery; D006260:Head Protective Devices / Q000191:economics; D006760:Hospitalization; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D007834:Lasers; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods; D061646:Operative Time; D010781:Photography; D010808:Physical Examination; D011183:Postoperative Complications; D016896:Treatment Outcome