title: Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis.
abstract: OBJECTIVE Historically, bilateral frontoorbital advancement (FOA) has been the keystone for treatment of turribrachycephaly caused by bilateral coronal synostosis. Early endoscopic suturectomy has become a popular technique for treatment of single-suture synostosis, with acceptable results and minimal perioperative morbidity. Boston Children's Hospital has adopted this method of treating early-presenting cases of bilateral coronal synostosis. METHODS A retrospective review of patients with bilateral coronal craniosynostosis who were treated with endoscopic suturectomy between 2005 and 2012 was completed. Patients were operated on between 1 and 4 months of age. Hospital records were reviewed for perioperative morbidity, length of stay, head circumference and cephalic indices, and the need for further surgery. RESULTS Eighteen patients were identified, 8 males and 10 females, with a mean age at surgery of 2.6 months (range 1-4 months). Nine patients had syndromic craniosynostosis. The mean duration of surgery was 73.3 minutes (range 50-93 minutes). The mean blood loss was 40 ml (range 20-100 ml), and 2 patients needed a blood transfusion. The mean duration of hospital stay was 1.2 days (range 1-2 days). There was 1 major complication in the form of a CSF leak. The mean follow-up was 37 months (range 6-102 months). Eleven percent of nonsyndromic patients required a subsequent FOA; 55.6% of syndromic patients underwent FOA. The head circumference percentiles and cephalic indices improved significantly. CONCLUSIONS Early endoscopic suturectomy successfully treats the majority of patients with bilateral coronal synostosis, and affords a short procedure time, a brief hospital stay, and an expedited recovery. Close follow-up is needed to detect patients who will require a secondary FOA due to progressive suture fusion or resynostosis of the released coronal sutures.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida; and.
authors.forename: S Alex
authors.initials: SA
authors.lastname: Rottgers
authors.affiliation: Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Subash
authors.initials: S
authors.lastname: Lohani
authors.affiliation: Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Proctor
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data; D002508:Cephalometry; D003393:Cranial Sutures / Q000000981:diagnostic imaging / Q000601:surgery*; D003398:Craniosynostoses / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D004724:Endoscopy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods* / Q000706:statistics & numerical data; D009989:Orthotic Devices; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: AP = anterior-posterior; FOA = frontoorbital advancement; ICP = intracranial pressure; ICU = intensive care unit; craniofacial; endoscopic; minimally invasive; syndromic craniosynostosis