Endoscope-assisted management of sagittal synostosis: wide vertex suturectomy and barrel stave osteotomies versus narrow vertex suturectomy.
OBJECTIVE Endoscope-assisted methods for treatment of craniosynostosis have reported benefits over open calvarial vault reconstruction. In this paper, the authors evaluated 2 methods for endoscope-assisted correction of sagittal synostosis: wide vertex suturectomy and barrel stave osteotomies (WVS+BSO) and narrow vertex suturectomy (NVS). METHODS The authors evaluated patients with nonsyndromic sagittal synostosis treated with either wide vertex suturectomy (4-6 cm) and barrel stave osteotomies (WVS+BSO) or narrow vertex suturectomy (NVS) (approximately 2 cm) between October 2006 and July 2013. Prospectively collected data included patient age, sex, operative time, estimated blood loss (EBL), postoperative hemoglobin level, number of transfusions, complications, and cephalic index. Fourteen patients in the NVS group were age matched to 14 patients in the WVS+BSO group. Descriptive statistics were calculated, and Student t-tests were used to compare prospectively obtained data from the WVS+BSO group with the NVS group in a series of univariate analyses. RESULTS The mean age at surgery was 3.9 months for WVS+BSO and 3.8 months for NVS. The mean operative time for patients undergoing NVS was 59.0 minutes, significantly less than the 83.4-minute operative time for patients undergoing WVS+BSO (p < 0.05). The differences in mean EBL (NVS: 25.4 ml; WVS+BSO: 27.5 ml), mean postoperative hemoglobin level (NVS: 8.6 g/dl; WVS+BSO: 8.0 g/dl), mean preoperative cephalic index (NVS: 69.9; WVS+BSO: 68.2), and mean cephalic index at 1 year of age (NVS: 78.1; WVS+BSO: 77.2) were not statistically significant. CONCLUSIONS The NVS and WVS+BSO produced nearly identical clinical results, as cephalic index at 1 year of age was similar between the 2 approaches. However, the NVS required fewer procedural steps and significantly less operative time than the WVS+BSO. The NVS group obtained the final cephalic index in a similar amount of time postoperatively as the WVS+BSO group. Complications, transfusion rates, and EBL were not different between the 2 techniques.
Division of Pediatric Neurosurgery, Department of Neurosurgery, and.
Brian J
BJ
Dlouhy
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis Children's Hospital, St. Louis, Missouri.
Dennis C
DC
Nguyen
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis Children's Hospital, St. Louis, Missouri.
Kamlesh B
KB
Patel
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis Children's Hospital, St. Louis, Missouri.
Gwendolyn M
GM
Hoben
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis Children's Hospital, St. Louis, Missouri.
Gary B
GB
Skolnick
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis Children's Hospital, St. Louis, Missouri.
Sybill D
SD
Naidoo
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University, St. Louis Children's Hospital, St. Louis, Missouri.
Albert S
AS
Woo
Division of Pediatric Neurosurgery, Department of Neurosurgery, and.
Matthew D
MD
Smyth
D015331:Cohort Studies; D003398:Craniosynostoses / Q000000981:diagnostic imaging* / Q000601:surgery*; D019468:Disease Management; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D044583:Neuroendoscopy / Q000379:methods*; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies
EAC = endoscope-assisted craniectomy; EBL = estimated blood loss; NVS = narrow vertex suturectomy; WVS+BSO = wide vertex suturectomy and barrel stave osteotomies; craniofacial; craniosynostosis; endoscopic; minimally invasive; sagittal synostosis; suturectomy