Our craniofacial team, led by Pediatric Plastic Surgeon Dr. Constance M. Barone and Pediatric Neurosurgeon, Dr. David F. Jimenez, has developed and successfully performed a newer and less invasive technique for the treatment of patients with craniosynostosis in the last eight years.

Using the aid of endoscopes, the surgical correction is done through one or two small scalp incisions (approximately 1"). The affected suture is removed (open) and the brain is allowed to grow normally and aided with the postoperative helmet therapy. Because the incisions are smaller, the need for blood transfusions has been significantly decreased (sagittal 10%, coronal 0%, metapic 10%, lambdoid 0%). Length of surgery is at or under one hour, and almost all patients have been discharged from the hospital on the morning following the surgery. The cost of hospitalization is also decreased significantly. However, best results are obtained when the babies are less than six months and preferably three months of age.

SAGITTAL SUTURE SYNOSTOSIS

The endoscopic treatment of sagittal craniosynostosis is done via two small incisions. One is placed behind the anterior fontanel (soft spot) and the other is placed further back on the head. The endoscopes are used to expose the areas above and below the skull, including the affected suture. Also, with endoscopic aid, the involved bone is removed, thereby freeing the brain and the skull to expand normally.

CORONAL SYNOSTOSIS

Dissection endoscopic release of the closed coronal suture is performed via a small single incision located halfway between the soft spot and the ear on the involved side. In all cases, only a very small amount of hair is removed. The stenosed suture is resected with bone cutting scissors and instruments. Unlike traditional treatment, facial and orbital swelling is not seen and minimal pain is experienced by the patients.

METOPIC SUTURE SYNOSTOSIS

The treatment of metopic suture synostosis is done via a single incision placed behind the hair line and across the mid-line. The endoscopes are used to elevate the scalp over the suture from the anterior fontanel down to the root of the nose (nasion). Once a small opening is made on the skull, the endoscopes are inserted under the bone and used to visualize the bone under the affected suture. A small strip of bone (0.7mm) is typically removed from the anterior fontanel to nasion, thereby releasing the closed stenosed suture.

LAMBDOID SUTURE SYNOSTOSIS

For releasing stenosed lambdoid sutures, two 1" incisions are made in the back of the head. One is made over the midline and the second one behind the affected ear. In a similar fashion, the stenosed lambdoid suture is removed with the aid and visualization of an endoscope. As with other sutures, the incisions are closed with subcutaneous absorbable sutures which do not require subsequent removal.

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