# Craniosynostosis — GCMD Library living collection

Also covered as: brachycephaly · turricephaly · plagiocephaly · torticollis · SIDS

Experts: Dr. Mark Proctor

Updated: n/a · 1 episodes · 50 cited statements

## Episodes
### Surgical Management
- [Endoscopic Treatment of Craniosynostosis: Pediatric Endoscopic Neurosurgery 2018](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381) — video · 34:23 · [machine version](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=0) Introduction and Craniosynostosis Anatomy (Ep 1)
- [2:27](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=147) Evolution of Surgical Approaches (Ep 1)
- [7:34](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=454) Endoscopic Technique for Sagittal Synostosis (Ep 1)
- [15:29](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=929) Helmet Therapy and Clinical Outcomes (Ep 1)
- [19:57](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1197) Conclusions and Treatment Paradigm (Ep 1)
- [20:57](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1257) Q&A Session (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "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" — Mark Proctor (clinical) [Ep 1 · 1:56](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=116)
- "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" — Mark Proctor (clinical) [Ep 1 · 2:27](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=147)
- "Craniosynostosis affects approximately 1 in 2000 live births with sagittal being the most common in about half of cases" — Mark Proctor (epidemiological) [Ep 1 · 2:54](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=174)
- "In sagittal synostosis, the back of the head is the narrowest part whereas normally it is the widest part" — Mark Proctor (clinical) [Ep 1 · 3:56](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=236)
- "In unilateral coronal synostosis, the nose always points up to the affected side" — Mark Proctor (clinical) [Ep 1 · 4:45](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=285)
- "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" — Mark Proctor (epidemiological) [Ep 1 · 5:18](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=318)
- "Historical strip craniectomy had poor results with about one-third of patients having bones fuse together before achieving correction" — Mark Proctor (clinical) [Ep 1 · 6:24](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=384)
- "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" — Mark Proctor (clinical) [Ep 1 · 7:59](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=479)
- "Endoscopic surgery is a release procedure that relies on brain growth to move bones out over time or requires adjuncts like springs or distractors" — Mark Proctor (clinical) [Ep 1 · 8:25](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=505)
- "Endoscopic approach conceptually turns synostosis into a deformational problem by opening bones to make them malleable, then reshaping with helmet" — Mark Proctor (clinical) [Ep 1 · 8:53](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=533)
- "Laparoscopic cholecystectomy was initially met with significant skepticism in 1987 but became standard of care" — Mark Proctor (opinion) [Ep 1 · 9:22](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=562)
- "Only surgeons involved with open cholecystectomy and management of its complications should perform laparoscopic cholecystectomy" — Mark Proctor (guideline) [Ep 1 · 10:47](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=647)
- "CDC parameters of care (2010-2012) consider endoscopic surgery a viable treatment option but stress need for very experienced team" — Mark Proctor (guideline) [Ep 1 · 11:11](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=671)
- "The endoscope is used primarily for lighting and visualization; some surgeons perform the same operation without endoscope" — Mark Proctor (clinical) [Ep 1 · 12:28](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=748)
- "A 0-degree endoscope is used, often not the high-quality neurosurgical scopes to avoid damage during this relatively blunt procedure" — Mark Proctor (clinical) [Ep 1 · 12:46](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=766)
- "Meticulous technique is necessary to keep blood transfusion rates down" — Mark Proctor (clinical) [Ep 1 · 13:14](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=794)
- "For sagittal synostosis, a 2 cm gap is the target width for bone removal" — Mark Proctor (clinical) [Ep 1 · 13:33](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=813)
- "Recent studies from Hopkins, DC, and Saint Louis show narrow (2 cm) strips are just as effective as wide (6 cm) strips" — Mark Proctor (clinical) [Ep 1 · 15:44](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=944)
- "Most centers have moved to narrow strip with no barrel staves on the side" — Mark Proctor (clinical) [Ep 1 · 15:59](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=959)
- "Helmet allows real-time adjustment; if top of head gets flat and needs more rounding, helmet can be adjusted, unlike springs or distractors" — Mark Proctor (clinical) [Ep 1 · 16:51](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1011)
- "Endoscopic results are very similar to open operation from cranial index perspective" — Mark Proctor (clinical) [Ep 1 · 17:18](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1038)
- "Head growth is very good and sustained over time with endoscopic approach" — Mark Proctor (clinical) [Ep 1 · 17:35](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1055)
- "Facial asymmetry improved significantly more in endoscopic group than frontal orbital group, attributed to early release" — Mark Proctor (clinical) [Ep 1 · 18:20](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1100)
- "Astigmatism improved much better with endoscopic surgery compared to open surgery" — Mark Proctor (clinical) [Ep 1 · 18:39](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1119)
- "In first 100 consecutive cases: mean surgical time 48 minutes, estimated blood loss 23 mL, 8 transfusions, median hospital stay 1 day" — Mark Proctor (clinical) [Ep 1 · 18:55](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1135)
- "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%" — Mark Proctor (clinical) [Ep 1 · 19:08](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1148)
- "Cost of endoscopic treatment is 40% of open operation, confirmed by three independent studies" — Mark Proctor (clinical) [Ep 1 · 19:25](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1165)
- "Cost analysis included all hospital costs, home costs, and gas mileage for families traveling to orthotist" — Mark Proctor (clinical) [Ep 1 · 19:43](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1183)
- "Ideal age for surgery is about 3 months (10-12 weeks)" — Mark Proctor (clinical) [Ep 1 · 22:37](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1357)
- "Oldest patient treated endoscopically was 7 months with mild sagittal synostosis; result was reasonable but less correction expected at that age" — Mark Proctor (clinical) [Ep 1 · 23:13](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1393)
- "Would not offer endoscopic treatment past 6 months for cranial index of 0.62, but reasonable to push to 5-6 months if starting cranial index is 0.7 or 0.72" — Mark Proctor (opinion) [Ep 1 · 23:34](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1414)
- "Without adjuvant treatment, would see similar 20-30% rate of suture closing back before significant correction" — Mark Proctor (clinical) [Ep 1 · 24:45](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1485)
- "For sagittal synostosis, helmet prevents front-to-back growth and promotes lateral growth; shooting for 2:1 growth ratio of width to length during helmet therapy" — Mark Proctor (clinical) [Ep 1 · 25:28](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1528)
- "Starting with cranial index of 0.75, after 6 months of helmet therapy expect to reach about 0.8" — Mark Proctor (clinical) [Ep 1 · 26:13](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1573)
- "Very important to track head circumference; do not want to stop growth or see fall-off on growth curve; ideally see slight jump up with operation" — Mark Proctor (clinical) [Ep 1 · 26:35](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1595)
- "Standard now is two IVs, no arterial line, no Foley catheter for endoscopic cases" — Mark Proctor (clinical) [Ep 1 · 27:49](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1669)
- "Some endoscopic patients could potentially go home same day, though speaker has not attempted this; many kept as 23-hour observations rather than formal admissions" — Mark Proctor (opinion) [Ep 1 · 28:16](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1696)
- "Well under 10-20% of patients require imaging to make diagnosis; average sagittal synostosis case is so classic that most can diagnose without imaging" — Mark Proctor (clinical) [Ep 1 · 30:11](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1811)
- "For sagittal synostosis, may consider just X-ray instead of CT scan as diagnosis is clear-cut" — Mark Proctor (clinical) [Ep 1 · 30:21](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1821)
- "Unilateral coronal can almost always be diagnosed on exam based on nasal deviation, height of eye, and ear position; rarely recommend scans" — Mark Proctor (clinical) [Ep 1 · 30:30](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1830)
- "Would never consider going surgically into lambdoid without CT scan; very difficult diagnosis to make" — Mark Proctor (opinion) [Ep 1 · 30:40](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1840)
- "Ultrasound literature is emerging showing ability to demonstrate open versus closed suture without radiation exposure" — Mark Proctor (clinical) [Ep 1 · 30:53](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1853)
- "Black bone MRI studies are potential viable alternative for showing suture status and brain detail without radiation" — Mark Proctor (clinical) [Ep 1 · 31:05](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1865)
- "For metopic synostosis, essentially no regression once desired shape is achieved; can stop helmet as soon as 3 months if correction obtained" — Mark Proctor (clinical) [Ep 1 · 32:03](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1923)
- "For sagittal synostosis, definite regression occurs; patients lose average of 0.02 cranial index between 1 and 2 years of age" — Mark Proctor (clinical) [Ep 1 · 32:27](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1947)
- "Average length of time in helmet for sagittal synostosis is 7 months from surgery" — Mark Proctor (clinical) [Ep 1 · 32:57](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1977)
- "For sagittal cases, push closer to one year in helmet unless cranial index exceeds 0.82" — Mark Proctor (clinical) [Ep 1 · 33:05](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1985)
- "For unilateral coronal, no regression but almost none are perfect at one year, so almost always go to one year of helmeting" — Mark Proctor (clinical) [Ep 1 · 33:23](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=2003)
- "Some surgeons (Jimenez) now standardly do 18 months of helmet for sagittal, but loss between 1-2 years is so small that helmet value is very small in that period" — Mark Proctor (opinion) [Ep 1 · 33:32](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=2012)
- "For coronal synostosis, also remove about 1-2 cm of bone, similar to sagittal; this is fairly standard among surgeons performing this operation" — Mark Proctor (clinical) [Ep 1 · 33:57](https://library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=2037)

## Changelog
- Aug 31: 1 doctors auto-found from episode dossiers
- Aug 30: 1 doctors auto-found from episode dossiers
- Aug 30: 1 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 3 doctors auto-found from episode dossiers
- Aug 29: 3 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 4 items, 4 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 4 items, 4 dossiers, summaries for 4 audience(s)

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