Mini-Invasive Endoscope-Assisted Treatment of Metopic Craniosynostosis: 2-Dimensional Operative Video.

ABSTRACT

The surgical treatment of trigonocephaly has undergone significant evolution, with an increasing use of a minimally invasive technique. The endoscope-assisted metopic suturectomy is currently considered a valid surgical option for the correction of metopic craniosynostosis.1-5 In this video-article, we present our surgical technique performed on a 5-month-old patient with type III (Genitori's classification6) trigonocephaly. The computed tomography (CT) scan showed fusion of the metopic suture with bitemporal narrowing and hypotelorism. The patient underwent endoscope-assisted metopic suturectomy, the width of the suturectomy is 1 cm, and an Esmarch sheet was used to protect the dura mater while drilling. Bridging veins are coagulated under endoscopic vision. The suturectomy is considered complete when the nasal cartilages are exposed, deconnecting thus completely the orbits. The postoperative CT scan showed the extent of the suturectomy. The patient did not present any neurological deficit or complications after surgery and was discharged on postoperative day 2. No helmet was used postoperatively. The patient repeated a head CT at age 11 years after head trauma and was seen at consultation. Interestingly, once the bone gap created after the metopic suturectomy reossifies, the frontal sinus develops normally. The long-term result was quite satisfying. The advantages of the mini-invasive technique consist in a smaller surgical scar, lower blood loss, shorter surgical time, and shorter hospital stay with good long-term results. The parents provided written consent for the publication of the patient's picture, the institutional research board approved the submission of this video article. In the video, the tips, tricks, and pitfalls of the technique are discussed.