gms | German Medical Science

Objective: Craniosynostosis is a premature pathologic ossification of one or several sutures of the skull. A child with a premature ossification of the sutures suffers a pathologic growth of the skull with a restricted growth in some areas and compensatory bossing in other areas. An increasing intracranial pressure is another well-known but rare complication of craniosynostosis. A surgical treatment is necessary for functional as well as cosmetic reasons. In the last few years, a minimally invasive endoscopic procedure is invented, developed and more and more performed to treat a wide range of patients with craniosynostosis.

Methods: Since 2013, 46 children with craniosynostosis were admitted to our department of neurosurgery for a surgical repair. We followed the endoscopic technique as main line of therapy for the patients younger than 4 month. 25 children with different types of craniosynostosis where operated endoscopically. A postoperative helmet therapy is considered to be a part of the endoscopic technique in the management of these cases. The follow up assessments take place 6 weeks, 3 months and 6 months after the surgery. A photo session as well as a 3d-photo-scan are the main follow-up measures that take place in each follow up assessment, so we can detect the efficiency of the treatment volumetrically and are able to optimize the therapy through the fine adjustments of the helmet.

Results: The endoscopic-controlled technique is a minimally invasive technique which allows us to reach the optimal functional und cosmetic results with a very small scar. A blood transfusion may not be needed as a very little amount of blood is lost. Only 12 Children out of 25 children needed blood transfusion, 4 children had the blood transfusion only intraoperatively, 7 children had the blood transfusion only postoperatively and only one child got the blood transfusion both intra- and postoperatively. Only one case which was operated endoscopically had undergone a re-operation ‘’Open surgery‘’ 7^th month later due to insufficient cosmetic result.

Conclusion: The endoscopic approach is a minimal invasive technique to treat craniosynostosis with a minimal risk of blood loss and low incidence of required intraoperative blood-transfusion. It is a fast surgery with a very small scar and optimal cosmetic and functional results for children younger than 4 months. The results of the endoscopic technique are as good as the open-surgery-results. The helmet therapy helps to optimize the results and to achieve the best skull-form. It is well-accepted and tolerated by the children. The duration of the helmet therapy is around one year but it can be shortened to 6 months in a lot of cases. Further studies are necessary to find out, whether this endoscopic technique is also a possible treatment option for the children older than 4 months or not.