Abstract
Introduction
Sagittal craniosynostosis represents the most frequent simplex skull suture pathology. There are currently several operative approaches to this defect. Minimally invasive techniques are preferred for young infants. Since July 2017, we have employed endoscopically assisted craniectomies followed by cranial orthosis. Gradually, we have developed our modified technique, the minimally invasive endoscopically assisted remodelation (MEAR).
Surgical technique
MEAR is a combination of principles gained from classical cranial vault remodeling techniques and minimal invasive approaches. The long and wider lateral osteoectomies performed in the parietal and occipital bones along with loosening of the periosteum and dura adhesions at the lambdoid sutures lead to early correction of parieto-occipital dimensions.
Results
Thirty-one consecutive patients with scaphocephaly underwent MEAR. The median preoperative cephalic index of 67 units (P25:63.3, P75:70) was improved to a median postoperative cephalic index of 77 units (P25:75, P75: 81). Sufficient correction was achieved in all patients. Cranial orthosis was needed for a median of 1.5 months (P25:1, P75:2). We had no major surgical complications in this pilot series.
Conclusions
With MEAR, we have achieved good cosmetic results. Duration of cranial orthosis was significantly shortened compared to conventional endoscopic-assisted procedures.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jimenez DF, Barone CM (1998) Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg 88:77–81
Jimenez DF, Barone CM (2012) Endoscopic technique for sagittal synostosis. Childs Nerv Syst 28:1333–1339
Di Rocco C (2003) How to decrease the impact of surgical scar in the correction of sagittal synostosis. Childs Nerv Syst 19:42–45
Massimi L, Di Rocco C (2012) Mini-invasive surgical technique for sagittal craniosynostosis. Childs Nerv Syst 28(9):1341–1345
Mutchnick IS, Maugans TA (2012) Nonendoscopic, minimally invasive calvarial vault remodeling without postoperative helmeting for sagittal synostosis: clinical article. J Neurosurg Pediatr 9(3):222–227
Pogliani L, Zuccotti GV, Furlanetto M, Giudici V, Erbetta A, Chiapparini L, Valentini L (2017) Cranial ultrasound is a reliable first step imaging in children with suspected craniosynostosis. Childs Nerv Syst 33:1545–1552
Liby P, Lomachinsky V, Felici G, Vaculik M, Krasnicanova H, Tichy M (2019) Sagittal craniosynostosis associated with midline cephalhematoma or vice versa, case report and a review of the literature. Childs Nerv Syst 35(4):729–732
Acknowledgments
We thank to Bc Eva Rajtmajerová for the 3D head scans and Dr. Jan Melichar for the initial patient’s images and USG scan. We thank Dr. Miroslav Vaculík for the critical discussions during MEAR development. We wish to acknowledge the late Professor Jiří Kozák, who was a driving force for the development of minimal invasive skull procedures in our institution. Parts of this work were presented at the Czech Neurosurgical Society meeting in Tvoršovice, Czech Republic, October 2019.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Informed consent
Informed consent was obtained from the next of kin.
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Liby, P., Lomachinsky, V., Taborsky, J. et al. Minimally invasive endoscopically assisted remodelation (MEAR) of sagittal craniosynostosis: an alternative technique to open and endoscopic procedures with cranial orthosis time span reduction. Childs Nerv Syst 37, 581–586 (2021). https://doi.org/10.1007/s00381-020-04836-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-020-04836-8