Endoscopic Treatment of Craniosynostosis Our Approach May 8, 1997 – March 30, 2005 Constance M. Barone, M.D. David F. Jimenez, M.D. University of Texas Health Science Center San Antonio, Texas

All Sutures Sagittal 108 M + 39 F = 147 Sagittal 108 M + 39 F = 147 Coronal 30 M + 37 F = 67 Coronal 30 M + 37 F = 67 Metopic 41M + 18 F = 59 Metopic 41M + 18 F = 59 Lambdoid 7M + 3F = 10 Lambdoid 7M + 3F = 10 Total number of patients = 283 Total number of patients = 283 Total number of sutures = 300 Total number of sutures = 300

Average Age of Pts. (Months) Sagittal 3.6 months Sagittal 3.6 months Coronal3.8 months Coronal3.8 months Metopic4.2 months Metopic4.2 months Lambdoid5.2 months Lambdoid5.2 months Average of all4.2 months Average of all4.2 months

Average Weight (kg) Avg Sagittal 6.30 Avg Sagittal 6.30 Avg Coronal 6.38 Avg Coronal 6.38 Avg Metopic 6.48 Avg Metopic 6.48 Avg Lambdoid 7.39 Avg Lambdoid 7.39 Avg all 6.63 Avg all 6.63

Estimated Blood Loss (cc) Sagittal 28.2 (avg) Sagittal 28.2 (avg) Coronal19.5 (avg) Coronal19.5 (avg) Metopic33.4 (avg) Metopic33.4 (avg) Lambdoid23.0 (avg) Lambdoid23.0 (avg) Overall Average26.0cc Overall Average26.0cc

Craniectomy Size (cm) Width x Length Width x Length Average Sagittal 5.5 cm x 10.4 Average Sagittal 5.5 cm x 10.4 Average Coronal 0.68 x 10.6 Average Coronal 0.68 x 10.6 Average Metopic0.71 x 9.8 Average Metopic0.71 x 9.8 Average Lambdoid1.6 x 7.5 Average Lambdoid1.6 x 7.5 Average of all surgeries 2.1 x 9.6 Average of all surgeries 2.1 x 9.6

Length of Stay (days) Avg Sagittal 1.07 Avg Sagittal 1.07 Avg Coronal1.03 Avg Coronal1.03 Avg Metopic1.00 Avg Metopic1.00 Avg Lambdoid1.00 Avg Lambdoid1.00 Avg all1.02 Avg all1.02

Operative Time (minutes) SagittalMetopicCoronal SagittalMetopicCoronal 57 (mean) (mean)

Blood Transfusions Sagittal Metopic Coronal Sagittal Metopic Coronal Intraop 2 (1.4%) 0 0 Intraop 2 (1.4%) 0 0 Postop 12 (8.5%) 4 (3.4%) 0 Postop 12 (8.5%) 4 (3.4%) 0 Total 14 (10%) 4 (3.4%) 0 Total 14 (10%) 4 (3.4%) 0

Results Sagittal Metopic Coronal Sagittal Metopic Coronal Incomplete ossification Incomplete ossification Abnl ossification Abnl ossification Dural Tear Dural Tear Coagulopathies Coagulopathies CSF leak CSF leak Venous air embolism 0 2 (II) 0 Venous air embolism 0 2 (II) 0 VP shunt VP shunt 3 0 0

Results Hematomas, Infections, Seizures, Convert to Open, Reoperation, Intrparenchymal Injury, Neurologic Injuries, Ocular Injuries, Injury to Sagittal Sinus = 0

Methods & Materials

SAGITTAL SUTURE

Pre OpImmediate Post-Op

Sagittal Results Cephalic Index Excellent: > 75 Excellent: > 75 Good Good Poor < 70 Poor < 70 Mean Preop CI: 67.4 (61 – 90) Mean Preop CI: 67.4 (61 – 90)

Sagittal Results Excellent 87% Excellent 87% Good 8.7% Good 8.7% Poor 4.3% Poor 4.3%

ENDOSCOPIC SURGERY RESULTS BEFORE AFTER

BEFOREAFTER 1 YEAR 3 YEARS

BEFOREAFTER

METOPIC

4 MONTHS POSTPRE - OP

1 YEAR POST

PRE - OP

preop 4 years

CORONAL

CORONAL SUTURE

SPHENOID’S LESSER WING FRONTAL DURATEMPORAL DURA

2 month female

CLINICAL CASES Patient: TM Patient: TM Age: 2 months Age: 2 months Sutural Involvement: Sutural Involvement: Left Coronal Left Coronal Sagittal Sagittal Left Lambdoid Left Lambdoid

Pre op 3 years

Pre op 2 yrs

Pre op 2 yrs

CLINICAL CASES Patient: NM Patient: NM Age: 2 months Age: 2 months Sutural Involvement: Sutural Involvement: Right Coronal Right Coronal Metopic Metopic

MULTIPLE SUTURES

Pre op1 yr3 yrs