New choices in craniosynostosis surgery: Less invasive, endoscopic craniosynostosis surgery

Catherine Mazzola, MD, FAANS

I had the pleasure of meeting Dr. David Jiminez in 2002, when I was first appointed by the Congress of Neurological Surgeons to the Council of State Neurosurgical Societies. Since both David and I are pediatric neurosurgeons, and we are both involved in organized neurosurgery, our paths have crossed numerous times. David started telling me about his new approach to craniosynostosis surgery in 2004, but long term results were not known at that time. Many neurosurgeons were skeptical, to say the least, about the cosmetic results of a more “conservative” surgery. Dr. Jiminez and his wife, and co-surgeon, Dr. Constance M. Barone, a Plastic-Craniofacial Surgeon, developed a less invasive, endoscopic treatment for infants with craniosynostosis. Craniosynostosis is a condition that develops in infants when the sutures, or spaces, in the skull fuse abnormally or prematurely. Typically, the sutures between the bones of the skull remain open, well into adulthood. The metopic suture is the only suture that closes, at about 4 months of age.

Craniosynostosis, or suture fusion, prohibits and restricts normal skull growth. Skull deformity results and the skull takes on an abnormal shape. This often affects the facial development of the infant as well. Craniosynostosis is a diagnosis made clinically, but can be confirmed radiologically, with skull x-rays or a CT scan. While surgery is the only way to “re-open” the fused suture, now the surgery can be done without the traditional “bi-coronal” or “ear to ear” incisions, once used in traditional surgery. The key to the surgery is making the diagnosis EARLY, and doing the less invasive surgery before the infant is 6 months old. Additionally, it is crucial to direct the corrective skull growth after surgery with a cranial molding helmet. The cranial molding helmet is an orthotic, made by a certified orthotist based on a computer guided image of the baby’s skull. The helmet allows for growth in certain areas, and restricts growth in other areas. Because the tendency of the skull is to follow the pattern set by the skull base, it is important to wear the helmet for 6 to 12 months after surgery.

The advantages of endoscopic surgery are multifold. The operative time is shorter, there is less blood loss and there is less need for transfusion. Additionally, the hospital stay is shorter and babies typically go home the day after surgery. The incision is smaller and more cosmetically appealing. The disadvantage is that the overall change in shape is not immediate. So, if there is significant restricted brain growth, macrocephaly or an elevated intracranial pressure, then the open, traditional surgery may be considered.

Dr. Daniel Pyo and I visited David and Connie in San Antonio and we spent time with them, reviewing their surgical technique and their follow-up data. The cosmetic results have been excellent. We started doing endoscopic craniosynostosis surgery here at Goryeb Children’s Hospital over a year ago. Parents couldn’t have been happier with the endoscopic surgery and the pediatricians have been amazed.

Parent satisfaction with both surgeries has been high. The cosmetic results have been excellent, as well. The Pediatric Anesthesiologists at Morristown Medical Center and the Pediatric Intensivists are important team members, along with all the care givers and health care providers in the AHS Craniofacial Center. For more about our craniosynostosis program, for questions or to make an appointment, please see the Craniofacial Team website at https://www.njcraniofacialcenter.com or call 973-971-8585. To watch a brief video about endoscopic craniosynostosis please view: http://www.youtube.com/watch?v=hDjYCyij3M4.