1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Operative Time (minutes) SagittalMetopicCoronal SagittalMetopicCoronal 57 (mean)5756 57 (mean)5756 25-15030-9025-60 25-15030-9025-60

9. 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

10. Results Sagittal Metopic Coronal Sagittal Metopic Coronal Incomplete ossification 0 2 3 Incomplete ossification 0 2 3 Abnl ossification 4 0 0 Abnl ossification 4 0 0 Dural Tear 1 0 0 Dural Tear 1 0 0 Coagulopathies 1 0 0 Coagulopathies 1 0 0 CSF leak 0 2 0 CSF leak 0 2 0 Venous air embolism 0 2 (II) 0 Venous air embolism 0 2 (II) 0 VP shunt 3 0 0 VP shunt 3 0 0

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

12. Methods & Materials

14. SAGITTAL SUTURE

17. Pre OpImmediate Post-Op

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

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

20. ENDOSCOPIC SURGERY RESULTS BEFORE AFTER

21. BEFOREAFTER 1 YEAR 3 YEARS

22. BEFOREAFTER

23. METOPIC

25. 4 MONTHS POSTPRE - OP

26. 1 YEAR POST

27. PRE - OP

28. preop 4 years

29. CORONAL

30. CORONAL SUTURE

31. SPHENOID’S LESSER WING FRONTAL DURATEMPORAL DURA

33. 2 month female

36. 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

44. Pre op 3 years

45. Pre op 2 yrs

48. Pre op 2 yrs

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

50. MULTIPLE SUTURES

51. Pre op1 yr3 yrs