Integrated Endoscopic Craniosynostosis Surgery and Cranial Orthosis Program.

INTRODUCTION: Craniosynostosis results from premature fusion of the cranial sutures. There has been a continuous evolution of surgical correction techniques from an extensive open procedure to the minimally invasive technique. AIMS AND OBJECTIVES: This novel surgical technique has never been previously done in the UAE and this article documents the experience of the first team to endoscopically correct craniosynostosis with planning, surgical techniques, and customized helmet therapy. METHODS: A retrospective case series of 16 nonsyndromic craniosynostosis patients with unicoronal (6), sagittal (5), bicoronal (1), frontosphenoidal (2), and metopic craniosynostoses (2) was corrected endoscopically and followed up with customized cranial helmet. Preoperative and postoperative photography, along with anthropometric measurements were taken. RESULTS: The mean age of all patients at the time of surgery was 101 (90-117) days, mean duration of surgery was 70 minutes (38-129), mean blood loss was 120 mL (100-150), and mean duration of hospital stay 4 days (4-5). No complications and mortality were reported. Mean number of helmets was 2 (1-3). Cranial index improved in all patients with sagittal and bicoronal craniosynostosis. Close cooperation with the orthotist ensured timely helmet therapy and accurate laser scanning documentation in head molding. CONCLUSIONS: This case series has demonstrated that endoscopically craniosynostosis correction is safe, effective, and reliable and is the first reported series from the Middle East. The authors believe that every patient with nonsyndromic single­suture craniosynostosis should be offered endoscopic correction before the age of 6 months. The orthotist forms an important part of the Multi-disciplinary team, enabling successful outcomes.

Endoscopic-assisted Surgery in the Treatment of Isolated Frontosphenoidal Craniosynostosis.

Isolated frontosphenoidal craniosynostosis is extremely rare, due to which diagnosis can be challenging. All the isolated cases reported have been treated by open surgical technique. We present a unique case report of an infant with an isolated frontosphenoidal synostosis corrected by a novel endoscopic surgical technique. The patient was a 5-month-old boy with worsening abnormal head shape indicating progressive right frontal bossing, left orbital displacement, and right occipital plagiocephaly. Computed tomography scan confirmed the diagnosis of left isolated frontosphenoidal craniosynostosis. Endoscopic-assisted surgical release was done starting with a 2.5-cm incision in the left temple area followed by a 2-cm strip osteotomy to excise the fused frontosphenoidal suture. Custom-made orthotic helmet therapy was started 2-weeks postsurgery, with excellent progress noted in the head shape confirmed by laser scans. The benefits of the endoscopic technique include smaller incision, decreased blood loss and need for blood transfusion, and decreased stay in hospital. This is the first case report showing the application of a novel endoscopic-assisted surgical treatment in an isolated frontosphenoidal craniosynostosis with no complications noted.