Craniosynostosis
Also covered as: brachycephaly · turricephaly · plagiocephaly · torticollis · SIDS
With Mark Proctor
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Answers come only from this collection's statement ledger and cite the exact moment · not medical advice
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Surgical Management
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Endoscopic Treatment of Craniosynostosis: Pediatric Endoscopic Neurosurgery 2018
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As a part of the Pediatric Endoscopic Neurosurgery 2018 Course, Dr. Mark Proctor discusses endoscopic treatment of craniosynostosis. He reviews types of craniosynostosis, compares open versus endoscopic surgery, and demonstrates surgical te
video · 34:23 · Sep 2018
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Every statement below comes from the recorded discussions, with its speaker and moment.
Endoscopic Treatment of Craniosynostosis: Pediatric Endoscopic Neurosurgery 2018
Human brain growth is very rapid in the first year of life, slows considerably over the second year, and past 2 years of age sutures play a very small role in skull or brain growth
clinicalMark Proctor1:56 ↗
Virchow's law defines that skull growth is normally perpendicular to sutures, and if bone is closed, growth occurs parallel to sutures due to compensatory overgrowth in other areas
clinicalMark Proctor2:27 ↗
Craniosynostosis affects approximately 1 in 2000 live births with sagittal being the most common in about half of cases
epidemiologicalMark Proctor2:54 ↗
In sagittal synostosis, the back of the head is the narrowest part whereas normally it is the widest part
clinicalMark Proctor3:56 ↗
In unilateral coronal synostosis, the nose always points up to the affected side
clinicalMark Proctor4:45 ↗
Lambdoid synostosis is very rare, representing about 1-2% of all synostosis cases, with approximately 1 case per year at a center seeing 100 new synostosis patients annually
epidemiologicalMark Proctor5:18 ↗
Historical strip craniectomy had poor results with about one-third of patients having bones fuse together before achieving correction
clinicalMark Proctor6:24 ↗
Open cranial vault reconstruction does not result in bones growing normally over time; results at end of surgery are not completely predictive of appearance 5-10 years later
clinicalMark Proctor7:59 ↗
Endoscopic surgery is a release procedure that relies on brain growth to move bones out over time or requires adjuncts like springs or distractors
clinicalMark Proctor8:25 ↗
Endoscopic approach conceptually turns synostosis into a deformational problem by opening bones to make them malleable, then reshaping with helmet
clinicalMark Proctor8:53 ↗
Laparoscopic cholecystectomy was initially met with significant skepticism in 1987 but became standard of care
opinionMark Proctor9:22 ↗
Only surgeons involved with open cholecystectomy and management of its complications should perform laparoscopic cholecystectomy
guidelineMark Proctor10:47 ↗
CDC parameters of care (2010-2012) consider endoscopic surgery a viable treatment option but stress need for very experienced team
guidelineMark Proctor11:11 ↗
The endoscope is used primarily for lighting and visualization; some surgeons perform the same operation without endoscope
clinicalMark Proctor12:28 ↗
A 0-degree endoscope is used, often not the high-quality neurosurgical scopes to avoid damage during this relatively blunt procedure
clinicalMark Proctor12:46 ↗
Meticulous technique is necessary to keep blood transfusion rates down
clinicalMark Proctor13:14 ↗
For sagittal synostosis, a 2 cm gap is the target width for bone removal
clinicalMark Proctor13:33 ↗
Recent studies from Hopkins, DC, and Saint Louis show narrow (2 cm) strips are just as effective as wide (6 cm) strips
clinicalMark Proctor15:44 ↗
Most centers have moved to narrow strip with no barrel staves on the side
clinicalMark Proctor15:59 ↗
Helmet allows real-time adjustment; if top of head gets flat and needs more rounding, helmet can be adjusted, unlike springs or distractors
clinicalMark Proctor16:51 ↗
Endoscopic results are very similar to open operation from cranial index perspective
clinicalMark Proctor17:18 ↗
Head growth is very good and sustained over time with endoscopic approach
clinicalMark Proctor17:35 ↗
Facial asymmetry improved significantly more in endoscopic group than frontal orbital group, attributed to early release
clinicalMark Proctor18:20 ↗
Astigmatism improved much better with endoscopic surgery compared to open surgery
clinicalMark Proctor18:39 ↗
In first 100 consecutive cases: mean surgical time 48 minutes, estimated blood loss 23 mL, 8 transfusions, median hospital stay 1 day
clinicalMark Proctor18:55 ↗
Weight under 5 kg was identified as risk factor for transfusion; now wait until over 5 kg and transfusion rates are down to about 3%
clinicalMark Proctor19:08 ↗
Cost of endoscopic treatment is 40% of open operation, confirmed by three independent studies
clinicalMark Proctor19:25 ↗
Cost analysis included all hospital costs, home costs, and gas mileage for families traveling to orthotist
clinicalMark Proctor19:43 ↗
Ideal age for surgery is about 3 months (10-12 weeks)
clinicalMark Proctor22:37 ↗
Oldest patient treated endoscopically was 7 months with mild sagittal synostosis; result was reasonable but less correction expected at that age
clinicalMark Proctor23:13 ↗