Malik Muhammad Nadeem, Lubna Bilal, Misbah-ul Hassan.
Early Treatment of Craniosynostosis by Using Endoscopic - Assisted Minimally Invasive Techniques.
Pak J Neuro Surg Jan ;17(1):31-4.

Object: The conventional calvarial remodeling procedures are being replaced by minimally invasive endoscopic-assisted suturectomies across the globe. The object of the study was to evaluate the efficacy of these minimally invasive techniques of strip craniectomies in our population.Material and Methods: A total of 70 patients, below 4 months of age, with metopic, coronal or sagittal suture premature fusion were treated during a period of three years from Nov. 2009 – Nov. 2012, using minimally invasive endoscopic-assisted techniques.Results: The sagittal suture synostosis group consisted of 28 patients, 19 males and 9 females with a mean age of 3 months. The group with coronal synostosis consisted of 17 patients, 8 males and 9 females with a mean age of 3.2 months. Metopic group consisted of 25 patients, 17 males and 8 females with a mean age of 2.3months. All these patient were chosen for minimally invasive strip craniectomies with the help of rigid neuroendoscope instead of conventional suturectomy. There were 4 intra-operative and 3 post-operative blood transfusions (10%). The mean surgical time was 55mins. All but 3 patients were discharged on 1st post-operative day (96%).Complications included 3 dural tears, 2 sagittal sinus injuries and 2 pseudo-meningoceles (10%). 2 cases had superficial wound infection of the skin and there was no mortality. Using anthropometric measurements and photographic assessment, excellent results were obtained in 78%, good results in 14% and poor in 8%.Conclusion: Coronal, metopic and sagittal synostosis can be treated at a very early age satisfactorily with minimally invasive endoscopic-assisted technique with good cosmetic results and limited blood loss.

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