Endoscopic Craniofacial Surgery

Treatment of Craniosynostosis: A Team Approach

With the newer endoscopic techniques, the earlier the surgery, the better the outcome. We recommend immediate referral for any patient with a serious head deformity secondary to craniosynostosis to determine if the patient qualifies for the endoscope or minimally invasive approach.

Endoscopic and Minimally Invasive Craniofacial Surgery

An innovative surgical procedure for craniofacial surgery is available at Rady Children’s. Surgeons make only small incisions and use specially designed optic devices called endoscopes. The endoscope is an instrument with extremely sophisticated optics that permits magnified visualization of the patient’s anatomy. It has been used in general surgery and patients generally have faster recovery times, smaller incisions and less blood loss.

4 month-old boy with Metopic Synostosis:  Before and after cranial reshaping:

Before (Pre-Op)
Image - Craniofacial - Metopic/Before
After Endoscopic Correction
(2 weeks Post-Op)
Image - Craniofacial - Metopic/After1
After Band Therapy
(5 months Post-Op)
Image - Craniofacial - Metopic/After3

Minimally invasive, endoscopically assisted strip craniectomy has been successful for early treatment of craniosynostosis. Physicians have reported excellent results for patients with sagittal synostosis when they use an endoscopic technique and combined strip synostectomy with postoperative helmet molding. By operating as early as possible, our group, along with others, have produced comparable results to standard cranial vault reshaping with less blood loss, shorter operating times and earlier discharge from the hospital.

2 month-old girl with Sagittal Synostosis- Before and 3 months after Endoscopic Correction:

Before After
Image - Craniofacial - Sagittal Synostosis Before/After

Traditional vs. Endoscopic correction:

Dr. Steven R. Cohen, Dr. Ralph E. Holmes and Dr. Hal S. Meltzer have developed a new technique that eliminates or shortens the need for postoperative helmet or band therapy. Our surgeons now use an improved endoscopic technique that permits more definitive head shape changes and immediate reconstruction of the skull deformity. By using extensive cranial osteotomies and wedge ostectomies together with rigid fixation using bioresorbable devices, immediate cranial reconstruction can be achieved in selected craniosynostosis patients who undergo the endoscopic-assisted technique.

Minimally Invasive Approach

  • Small incisions will be made in the scalp within the hair and sometimes along the crease of the upper eyelids.
  • Using a small lighted endoscope, the operation will be projected onto a TV screen.
  • Resorbable devices may be used for bone stabilization.
  • Post-operative helmet or band will be prescribed in many cases to “fine tune” the shape of the skull.
  • The helmet may be needed up to three months.
  • Your child will be fitted with a helmet 10 to 14 days after the operation.

Conditions Treated With The Endoscopic-Assisted Approach:

  • Sagittal synostosis
  • Metopic synostosis
  • Coronal synostosis
  • Selected syndromic synostoses
  • Hemangioma resection
  • Nasal dermoid removal
  • Miscellaneous tumors
  • Placement of tissue expander
  • Lesion removal
Image - Craniofacial - Metopic Diagram

Endoscopic approach for metopic synostosis: small incisions allow access. The bones are cut with endoscopic guidance and small biodegradable plates are used for stabilization.

Biodegradable Devices

Dr. Cohen and Dr. Holmes are pioneers in the use of biodegradable devices in cranio-maxillofacial surgery. They have worked closely with leading bioresorbable device-makers to develop numerous new techniques that use fixation devices that eventually dissolve and are absorbed by the body. Instead of metal plates, biodegradable devices are also being used in endoscopic craniofacial surgery to reduce the need for postoperative helmet or band therapy.

Summary

Most major craniofacial teams have individualized their operative approach to obtain the best aesthetic outcomes and lowest reoperation rates. Total cranial vault reconstruction is a major operative procedure not without morbidity.

A new technique combining an endoscopic-assisted approach with postoperative helmet molding for treatment of sagittal synostosis has had excellent results. Disadvantages of this approach are the prolonged need for postoperative helmet molding and limitations when it comes to treating severe variations in scaphocephaly.

We have developed an operative approach that incorporates extensive corrective osteotomies and ostectomies with immediate correction with or without specially designed bioresorbable plates and screws. Our results are encouraging, and we now treat selected patients with all types of single-suture craniosynostoses, including unicoronal and metopic, with the endoscopic minimally invasive approach. With more experience, it may be possible to eliminate the need for postoperative helmets in patients with sagittal synostosis, as well as in the correction of other types of single suture craniosynostoses.