Editorial: Endoscopy-assisted craniosynostosis
نویسنده
چکیده
the effectiveness and the complications associated with the treatment of 139 patients with sagittal synostosis who had undergone endoscopy-assisted wide-vertex craniectomies and barrel stave osteotomies. These infants were treated with postoperative molding helmets for 1 year. They ranged in age from 2 weeks to 9 months. The authors report that visually the results were uniformly excellent and corroborate this by using cephalic index measurements. They also describe no significant complications, with the need for blood transfusion in only two patients intraoperatively and 12 patients overall. The indications for transfusion were a hematocrit of less than 19 and a pulse rate greater than 170. Most patients were discharged on the 1st postoperative day (132 patients [95%]). The authors further state that there were no dural tears and no intraparenchymal cerebral hemorrhages or air emboli. On the surface, this approach has a significant number of appealing features: a smaller or less conspicuous scar in childhood, shorter operating time, and overall low morbidity rate. Before one concludes that this is the optimal treatment of patients with sagittal synostosis, some additional factors need to be clarified. First, the authors state that there were no dural tears nor intracerebral hemorrhages. The authors did not, however, report a routine evaluation of the children’s skull and brain by using objective measures, such as computerized tomography (CT) scanning, in the immediate postoperative period to define this. The incidence of intracranial hemorrhage therefore cannot be stated based on the information provided because some of these complications may be “silent.” The endoscopic approach—which I have used, on occasion, with a rigid endoscope—as the authors have described, restricted visualization, particularly laterally, in the basal skull. In the abstract, the authors describe that they have performed temporal barrel stave osteotomies, which would require crossing a patent squamosal suture. In most children, this requires a significant depression of the surface contour of the dura and underlying brain because of the convex nature of the frontal, parietal, and temporal lobes. In the body of the text, however, the authors indicate that the barrel stave osteotomies come to the level of the squamosal suture, and it is unclear based on the abstract whether the craniotomies are beyond the suture. It is probable with the use of scissors, which the authors describe as their cutting instrument, that at some point either a significant depression of the brain and contusion of the brain surface or dural laceration and hemorrhage could occur. The third issue relates to the width of the craniectomy. The authors state that the mean width of the craniectomy defect is routinely 5.4 cm, with a skin incision line of 2 to 2.5 cm. This would mean that all the bone would have to be cut at least in half, if not thirds, to remove the bone segments. This would also indicate that the incision lines would tend to be more than 2.5 cm long (the photograph in Fig. 3F suggests that this scar may be longer than 2.5 cm, at least in some cases). Concern regarding the long-term consequences of a large defect over the sagittal sinus is also raised. In cases in which this amount of bone has been removed in my own practice, thinner or incomplete bone formation occurred years later. The vertex of the skull produces a less effective remineralization of the cranial defect compared with frontal and temporal regions. The authors do not describe the extent of remineralization of the defect area nor do they provide any CT scanning evidence of the thickness of regnerated bone in this region. This is important because one needs to judge whether the skull is going to be sufficiently thick and durable to allow for normal childhood activities and participation in sports later in life.
منابع مشابه
Endoscopy-assisted wide-vertex craniectomy, "barrel-stave" osteotomies, and postoperative helmet molding therapy in the early management of sagittal suture craniosynostosis.
OBJECT The purpose of this study was to assess the efficacy, safety, associated complications, and outcome in patients with sagittal suture craniosynostosis in whom endoscopy-assisted wide-vertex craniotomy and "barrel-stave" osteotomy were performed. METHODS During a 4-year period, 59 patients with sagittal suture synostosis underwent endoscopy-assisted wide-vertex craniectomies, barrel stav...
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Background Surgical methods to treat craniosynostosis have evolved from a simple strip craniectomy to a diverse spectrum of partial or complete cranial vault remodeling with excellent results but often with high comorbidity. Therefore, minimal invasive craniosynostosis surgery has been explored in the last few decades. The main goal of minimal invasive craniosynostosis surgery is to reduce the ...
متن کاملEndoscopically assisted correction of sagittal craniosynostosis.
Craniosynostosis is premature fusion of one or more of the cranial sutures of an infant's skull. Several sutures may be fused, alone or in combination. The endoscopically assisted approach to correcting craniosynostosis is an alternative to more traditional techniques, such as open-strip craniectomy and the Pi procedure for infants younger than four months of age and the cranial vault remodelin...
متن کاملMultiple-suture nonsyndromic craniosynostosis: early and effective management using endoscopic techniques.
OBJECT The authors present the results of treating infants with multiple-suture nonsyndromic craniosynostosis in whom the authors used minimally invasive endoscopy-assisted techniques and postoperative cranial molding over an 11-year period. METHODS A total of 21 patients who presented with multiple-suture (nonsyndromic) craniosynostosis were treated using minimally invasive endoscopy-assiste...
متن کاملEndoscopic-assisted repair of craniosynostosis.
OBJECT The goal of the craniofacial surgeon has always been the correction of form and function with prevention of associated morbidity and death. Through the pioneering work of Jimenez and Barone, minimally invasive approaches to the surgical correction of craniosynostosis are now gaining wider acceptance. Here the authors review the technique for endoscopic-assisted repair of craniosynostosis...
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We present a new method to analyze, classify and characterize 3D landmark-based shapes. It is based on a framework provided by oriented matroid theory, that is on a combinatorial encoding of convexity properties. We apply this method to a set of skull shapes presenting various types of coronal craniosynostosis.
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تاریخ انتشار 2004