Endoscopic assisted suturectomy for primary craniosynostosis in infancy

Abstract

Ramadan Shamseldien, Hedaya Hendam and Abdelhfiz Shehbeldien

Background: Multiple procedures have been used for the treatment of craniosynostosis, ranging from simple suturectomy to extensive calvarial vault remodeling. The optimal timing for surgery is still controversial. The goal of therapy is to provide adequate intracranial volume, in addition to an aesthetically almost normal skull shape. Endoscopic synostosis repair described in 1998 by Jimenez and Baron [1]. This technique allows for a less invasive method that can result in excellent longstanding reconstruction of the cranial skeleton. This method is a minimally invasive approach that has less morbidity involved with traditional reconstruction techniques.

Aim: Evaluation of early endoscopic suturectomy and its impact on both neurological functions and cosmetic appearance of infants up to 6 months of age suffering primary craniosynostosis.

Methodology: This is a prospective analytical study of 50 patients with primary non syndromic craniosynostosis either single suture or multiple sutures, up to sixth months of age; with evident of skull shape deformity and or manifestations of increase intracranial pressure. from; October 2009 to October 2016 were managed byendoscopic assisted suturectomy the approach of Jimenez and Baron, in both Neurosurgery Department Shebin Elkom teaching hospital and Neurosurgery Department in Elsahel teaching hospital. Clinical and radiological follow up for six months postoperative.

Results: This is a prospective analytical study of 50 patients with primary craniosynostosis, 28 patients are male and 22 patients are female. The age of patients range from one and half months to sixth months. The majority of cases presented with deformity alone 68%. Other clinical presentations as manifestations of increased intracranial pressure, fits, and delayed milestones plus deformity was 20%, 8%, and 4% respectively. Estimated blood loss, the mean loss was 56cc, minimum 30cc, and maximum was 100cc, with stander deviation ±18cc.The minimum hospital stay was one day and maximum was three days.There is significant change of head shape and head circumference postoperatively this observed by highly significant P value in head circumference (< 0.001).

Conclusion: Endoscopic assisted suturectomy is minimally invasive approach with a very narrow range of complications, very limited need to blood transfusion and if it occurs, it is small volume in relation to total volume. Very short ICU and hospital stay also decrease the economic load.

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