Evaluation of neurocognitive and social developments after craniosynostosis surgery.

OBJECTIVE: The study focused on assessing the potential neurocognitive and social developmental issues in children with non-syndromic craniosynostosis (NSC) who received optimal surgical treatment. The primary objective was to determine whether NSC, even after optimal surgical treatment, could have negative effects on brain development. METHODS: The study included a total of 73 pediatric patients aged between 2 and 6 years who had previously undergone surgery for NSC at the Gazi University Faculty of Medicine, Department of Neurosurgery. These patients were carefully matched with 107 healthy children who visited the outpatient clinic of the same department in terms of sociodemographic characteristics such as age, gender, and social status. To assess the neurocognitive and social development of the participants, the child psychologist administered a developmental scale to the child and his/her family via video conference. This scale was adapted from the Bayley-III Infant and Child Development Scale by the Gazi University Faculty of Medicine, Division of Pediatric Neurology. RESULTS: The study found no social or gross motor developmental issues in patients who had undergone optimal surgical treatment for NSC. However, the risk of fine motor developmental deficiencies was 4.79 times higher than that of the normal population, and the risk of language developmental deficiencies was 5.75 times higher than that of the normal population. CONCLUSIONS: Despite timely treatment of NSC, long-term neurocognitive and social development issues may arise in affected children. Therefore, it is crucial to monitor these patients after completing surgical treatment and thoroughly examine their development using a multidisciplinary approach.

Transorbital neuroendoscopic surgery for treatment of sphenoid wing meningiomas extending to the cavernous sinus: clinical implications and a technical illustration.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of transorbital neuroendoscopic surgery (TONES) in the management of sphenoid wing meningiomas (SWMs) with cavernous sinus and orbital invasion. METHODS: The authors conducted a retrospective review of 32 patients with SWMs treated at Gazi University using TONES from October 2019 to May 2023. The study includes clinical applications to elucidate the endoscopic transorbital approach. Surgical techniques focused on safe subtotal resection, aiming to minimize residual tumor volume for subsequent radiosurgery. Data were collected on patient demographics, tumor characteristics, surgical procedures, complications, and postoperative outcomes, including radiological imaging and ophthalmological evaluations. RESULTS: Surgical dissections delineated a three-phase endoscopic transorbital approach: extraorbital, intraorbital, and intracranial. In the clinical application, gross-total resection was not achieved in any patient because of planned postoperative Gamma Knife radiosurgery. The mean follow-up period was 16.3 months. Of 30 patients with preoperative proptosis, 25 experienced postoperative improvement. No new-onset extraocular muscle paresis or visual loss occurred postoperatively. The average hospital stay was 1.15 days, with minimal complications and no significant morbidity or mortality. CONCLUSIONS: Total resection of SWMs invading the cavernous sinus and orbit is associated with substantial risks, particularly cranial nerve deficits. TONES offers a minimally invasive alternative, reducing morbidity compared with transcranial approaches, and represents a significant advancement in the surgical management of SWMs, especially those extending into the cavernous sinus and orbit. The approach provides a safe, effective, and patient-centric approach, prioritizing subtotal resection to minimize neurological deficits while preparing patients for adjunctive radiosurgery. This study positions TONES as a transformative surgical technique, aligning therapeutic efficacy with neurovascular preservation and postoperative recovery.

Endoscopy-Assisted Suturectomy: Can It be the Priority Choice in the Treatment of Metopic Synostosis?

AIM: Craniosynostosis is a clinical condition that goes with cranial deformities caused by early ossification of fibrous tissue at the suture line. The rate of metopic synostosis has been increasing in recent years. Our aim in this article is to mathematically present the results of endoscopic assisted surgery in the treatment of metopic synostosis. MATERIAL AND METHODS: We present a follow-up of the stages of treatment of 43 patients with metopic synostosis who underwent surgery in a multicenter retrospective study between 2018 and 2021. We developed the formula D3/((D1+D2)/2) based on the theory of "The Angle of a Triangle Opposite The Longest Side is the Largest Angle". And we called this method \'Metopic Angle Proportion (MAP)'. Paired samples T-test was performed for statistical results. P value 0.05 was considered statistically significant. RESULTS: According to the MAP method; measurements for frontal enlargement, mean pretreatment length D1: 34,57 mm, D2: 34,81 mm, D3: 60,46 mm, and the end of treatment as D1: 37,88 mm, D2: 38,19 mm, D3: 71,09 mm. We perfomed the formula D3/((D1+D2)/2). While this rate was 1.74 before treatment, it increased to 1.87 after treatment. As a result of statistical analysis, it was also found to be significant (p≤0.05). CONCLUSION: Studies have shown that the rate of trigonocephaly increases between synostoses. This shows that the treatment rate is increasing. As a treatment option , open vault surgery is an older and more familiar technique. However, this method has disadvantages such as long surgical time, higher blood loss, the need for intensive care in the postoperative period, and the surgeon\'s dependence on experience and 3D thinking skills. However, Endoscopic assisted surgery offers a more comfortable surgery and better results.Endoscopy-assisted suturectomy can be applied in many health centres because it is safe, easy and cheaper.