Minimally Invasive Correction of Anterior Calvarial Synostosis without the Use of Helmets

[摘要] Background: Surgery for craniosynostosis has significant morbidities. Attention has shifted back to less invasive procedures while operating at an earlier stage. Objective: To describe a minimally invasive approach for the treatment of infants with anterior calvarial craniosynostosis. The approach employs tailored frontal osteotomies and linear craniectomy of the synostosed suture to reconstruct the anterior calvarial deformity while eliminating the need for postoperative helmet molding. Methods: The authors have operated upon 17 patients with anterior calvarial synostosis with the minimally invasive technique without the use of the endoscope. The study included 8 patients with unicoronal synostosis, 4 patients with brachycephaly, and 5 patients with metopic synostosis.  The age of patients ranged from 2 to 9 months. The approach incorporates linear craniectomy of the suture and frontal “benz sign” and supraorbital osteotomies. Postoperative helmet molding was not employed. Results: The follow-up period ranged from 3-19 months with a mean of 11.4 months. Average blood loss was less than 50 cc in cases of single suture synostosis and less than 100 cc in bicoronal synostoses.  Peri-operative complications were dural tears in three patients with no consequences in two of them. Satisfactory to excellent cosmetic results were obtained in all patients.  Recurrent deformity was not noted in any of the patients during the follow-up period. Conclusion: Frontal osteotomies seem to be a valuable addition to the “minimal invasive” correction of metopic and coronal synostosis. They allow faster and better correction without the inconvenience or the cost of the helmet. Though the patient number and follow-up period are still limited, the preliminary results have been quite encouraging. [Egypt J Neurol Psychiat Neurosurg.  2010; 47(4): 555-562]

[学科分类] 精神健康和精神病学