Craniosynostosis
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.
Content of this collection
Surgical Management
1 item
Endoscopic Treatment of Craniosynostosis: Pediatric Endoscopic Neurosurgery 2018
Watch →
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
video34:23 · Sep 2018
Summaries and takeaways+ Show
Summary of this collection+ Show
Key points, with the moment each was said+ Show
Featured picks for families are being prepared — the summaries above are written for you.
Takeaways+ Show
The doctors in this collection+ Show
All expert statements+ Show
Every expert statement below comes from the recorded discussions, with its speaker and moment.
Endoscopic Treatment of Craniosynostosis: Pediatric Endoscopic Neurosurgery 2018
Human skull is made up of 5 major bones separated by growth plates called sutures.
clinicalMark Proctor1:25 ↗
Humans have very rapid brain growth in the first year of life, slowing considerably over the second year; 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 the sutures; if bone is closed, growth occurs parallel to sutures due to compensatory overgrowth in other areas.
clinicalMark Proctor2:27 ↗
Synostosis affects about 1 in every 2000 live births, with sagittal being by far the most common in about half of children.
epidemiologicalMark Proctor2:54 ↗
In sagittal synostosis, the back of the head is the narrowest part (whereas normally it is the widest), with wide and bossed frontal region.
clinicalMark Proctor3:56 ↗
In unilateral coronal synostosis, there is orbital dystopia where the orbit on the affected side is higher and shallower, and the nose deviates toward the affected side.
clinicalMark Proctor4:27 ↗
Lambdoid synostosis is very rare, representing about 1 to 2% of all synostosis cases; Boston Children's sees about 100 new synostosis patients per year and averages 1 lambdoid case annually.
epidemiologicalMark Proctor5:20 ↗
In lambdoid synostosis, the mastoid should be low (extended) on the affected side, which helps distinguish it from deformational changes.
clinicalMark Proctor5:37 ↗
Strip craniectomy results were poor historically, with about one-third of patients having bones fuse together before significant correction, leading to adoption of larger cranial vault reconstructions.
clinicalMark Proctor6:14 ↗
David Jimenez and Constance Barone in the mid-1990s pioneered endoscopic synostosis surgery with smaller incisions, less blood loss, and adjuvant helmet therapy.
clinicalMark Proctor6:46 ↗
Open surgery is a mechanical operation where bones are repositioned and fixed, but those bones don't grow normally over time; results at end of surgery aren't completely predictive of outcomes 5 or 10 years later.
clinicalMark Proctor7:51 ↗
Endoscopic surgery is a release procedure that relies on brain growth to move bones out over time or requires adjuncts like springs, distractors, or helmets to direct growth.
clinicalMark Proctor8:25 ↗
Conceptually, endoscopic surgery turns synostosis into a deformational problem by opening bones to make them malleable, then reshaping with a helmet.
clinicalMark Proctor8:53 ↗
Laparoscopic cholecystectomy was first reported in 1987 by a team in France and met significant early skepticism before becoming standard of care.
clinicalMark Proctor9:22 ↗
Only surgeons involved with open cholecystectomy and management of its potential complications should perform laparoscopic cholecystectomy (quote from historical article applied to craniosynostosis context).
opinionMark Proctor10:47 ↗
CDC parameters of care for synostosis (2010–2012) consider endoscopic surgery a viable treatment option but stress the need for a very experienced team.
guidelineMark Proctor11:11 ↗
For sagittal synostosis endoscopic surgery, a 0-degree endoscope is used; Proctor avoids using high-quality neurosurgical scopes to prevent damage in this relatively blunt procedure.
clinicalMark Proctor12:46 ↗
Meticulous technique is necessary to keep blood transfusion rates down in endoscopic craniosynostosis surgery.
clinicalMark Proctor13:14 ↗
For sagittal synostosis, two incisions are made (anterior and posterior), burr holes created and expanded with Kerrison rongeurs to about a 2 cm gap.
clinicalMark Proctor13:22 ↗
Recent studies from Hopkins, DC, and Saint Louis show that narrow (2 cm) bone strips are just as effective as wide (6 cm) strips; most centers now use narrow strips with no barrel staves.
clinicalMark Proctor15:44 ↗
Helmets allow real-time adjustment (e.g., if top of head is getting flat, can adjust for more rounding), whereas springs or distractors cannot be adjusted.
clinicalMark Proctor16:51 ↗
Endoscopic treatment leads to sustained changes in cranial index over time, with results very similar to open operation from a cranial index perspective (compared by multiple groups).
clinicalMark Proctor17:14 ↗
In unilateral coronal synostosis treated endoscopically, neo-suture formation can occur, making it appear as if the patient never had a fused suture.
clinicalMark Proctor17:51 ↗
3D photogrammetry studies show facial asymmetry improved significantly more in the endoscopic group than in the frontal orbital advancement group, likely due to early release.
clinicalMark Proctor18:20 ↗
Astigmatism improved much better with endoscopic surgery compared to open surgery.
clinicalMark Proctor18:39 ↗
First 100 consecutive endoscopic cases (all synostosis types): 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 a risk factor for transfusion; now waiting until over 5 kg for all patients, transfusion rates down to about 3%.
clinicalMark Proctor19:08 ↗
Cost of endoscopic treatment is 40% of open operation; three studies (Boston, Saint Louis, Midwest US) show consistent results.
clinicalMark Proctor19:25 ↗
Boston cost study included all hospital costs, home costs, and gas mileage for families traveling to orthotist appointments.
clinicalMark Proctor19:43 ↗
In experienced centers, both open and endoscopic craniosynostosis surgery should be very safe procedures.
opinionMark Proctor20:07 ↗
What's new+ Show