Endoscopic Endoscopic Treatment of Treatment of

Craniosynostosis Craniosynostosis Our ApproachOur ApproachMay 8, 1997 – May 8, 1997 –

March 30, 2005March 30, 2005Constance M. Barone, M.D.Constance M. Barone, M.D.

David F. Jimenez, M.D.David F. Jimenez, M.D.

University of Texas Health Science CenterUniversity of Texas Health Science CenterSan Antonio, TexasSan Antonio, Texas

All SuturesAll Sutures

Sagittal 108 M + 39 F = 147Sagittal 108 M + 39 F = 147 Coronal 30 M + 37 F = 67Coronal 30 M + 37 F = 67 Metopic 41M + 18 F = 59Metopic 41M + 18 F = 59 Lambdoid 7M + 3F = 10Lambdoid 7M + 3F = 10

Total number of patients = 283Total number of patients = 283 Total number of sutures = 300Total number of sutures = 300

Average Age of Pts. Average Age of Pts. (Months)(Months)

Sagittal Sagittal 3.6 months3.6 months CoronalCoronal 3.8 months3.8 months MetopicMetopic 4.2 months4.2 months LambdoidLambdoid 5.2 months5.2 months Average of allAverage of all 4.2 4.2

monthsmonths

Average Weight (kg)Average Weight (kg)

Avg Sagittal Avg Sagittal 6.30 6.30 Avg CoronalAvg Coronal 6.38 6.38 Avg MetopicAvg Metopic 6.48 6.48 Avg LambdoidAvg Lambdoid 7.39 7.39

Avg all Avg all 6.636.63

Estimated Blood Loss Estimated Blood Loss (cc)(cc)

Sagittal Sagittal 28.2 (avg)28.2 (avg) CoronalCoronal 19.5 (avg)19.5 (avg) MetopicMetopic 33.4 (avg)33.4 (avg) LambdoidLambdoid 23.0 (avg)23.0 (avg)

Overall AverageOverall Average 26.0cc26.0cc

Craniectomy Size (cm)Craniectomy Size (cm)

Width x Width x LengthLength

Average Sagittal 5.5 cm x 10.4Average Sagittal 5.5 cm x 10.4 Average Coronal 0.68 x 10.6Average Coronal 0.68 x 10.6 Average MetopicAverage Metopic 0.71 x 9.80.71 x 9.8 Average LambdoidAverage Lambdoid 1.6 x 7.51.6 x 7.5

Average of all surgeries 2.1 x 9.6Average of all surgeries 2.1 x 9.6

Length of Stay (days)Length of Stay (days)

Avg Sagittal Avg Sagittal 1.071.07 Avg CoronalAvg Coronal 1.031.03 Avg MetopicAvg Metopic 1.001.00 Avg LambdoidAvg Lambdoid 1.001.00

Avg allAvg all 1.021.02

Operative Time Operative Time (minutes)(minutes)

SagittalSagittal MetopicMetopicCoronalCoronal

57 (mean)57 (mean) 5757 5656

25-15025-150 30-9030-9025-6025-60

Blood TransfusionsBlood Transfusions

Sagittal Metopic Sagittal Metopic CoronalCoronal

Intraop 2 (1.4%) 0 0Intraop 2 (1.4%) 0 0

Postop 12 (8.5%) 4 (3.4%) 0Postop 12 (8.5%) 4 (3.4%) 0

Total 14 (10%) 4 (3.4%) Total 14 (10%) 4 (3.4%) 00

ResultsResults

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

ResultsResults

Hematomas, Infections, Seizures, Hematomas, Infections, Seizures, Convert to Open, Reoperation, Convert to Open, Reoperation,

Intrparenchymal Injury, Intrparenchymal Injury, Neurologic Injuries, Ocular Neurologic Injuries, Ocular

Injuries, Injury to Sagittal Sinus Injuries, Injury to Sagittal Sinus = 0= 0

Methods & MaterialsMethods & Materials

SAGITTAL SUTURESAGITTAL SUTURE

Pre Op Immediate Post-Op

Sagittal ResultsSagittal Results

Cephalic IndexCephalic Index• Excellent: Excellent: > 75 > 75• Good Good 70 -7570 -75• PoorPoor < 70 < 70

• Mean Preop CI: 67.4 Mean Preop CI: 67.4 (61 – 90)(61 – 90)

Sagittal ResultsSagittal Results

• Excellent Excellent 87% 87%

• Good Good 8.7% 8.7%

• Poor Poor 4.3%4.3%

ENDOSCOPIC SURGERY ENDOSCOPIC SURGERY RESULTSRESULTS

BEFORE AFTER

BEFORE AFTER

1 YEAR

3 YEARS

BEFORE AFTER

METOPICMETOPIC

4 MONTHS POSTPRE - OP

PRE - OP 1 YEAR POST

1 YEAR POSTPRE - OP

preop preop 4 years 4 years

CORONALCORONAL

CORONAL SUTURECORONAL SUTURE

CORONAL SUTURECORONAL SUTURE

SPHENOID’S LESSER WINGFRONTAL DURA TEMPORAL DURA

2 month female2 month female

CLINICAL CASESCLINICAL CASES

Patient: Patient: TMTM Age: Age: 2 months2 months Sutural Sutural

Involvement:Involvement: Left CoronalLeft Coronal SagittalSagittal Left Lambdoid Left Lambdoid

Pre op3 years

Pre op 2 yrs

Pre op 2 yrs

CLINICAL CASESCLINICAL CASES

Patient: Patient: NMNM Age: Age: 2 months2 months Sutural Sutural

Involvement:Involvement: RightRight Coronal Coronal Metopic Metopic

MULTIPLE SUTURESMULTIPLE SUTURES

Pre op 1 yr 3 yrs