Article Reviews & Commentary
Article Reviews by Thomas J. Mancuso, MD, FAAP
Early Management of Craniosynostosis.
Jiminez DF, Barone CM, Cartwright CC et al
Pediatrics 2002:110;97-104
The Misshapen Head.
Maugans T Pediatrics 2002:110;166-167
This report, from the Center for Craniofacial disorders at the University of Missouri Hospitals, is a description of an early treatment of craniosynostisis with minimally invasive endoscopic strip craniectomies and a postoperative helmet for molding of the cranium. One-hundred children were studied prospectively. All underwent strip craniectomies and wore custom-made helmets for up to 7 months afterward. The children were between 0.5-9.5 months of age (mean 3.1 months), with 72 boys. The distribution of affected sutures was: sagittal 61, coronal 20, metopic 18, lamboid 4. Mean surgical time was 53 minutes and mean EBL was 26 ml. One patient underwent intraoperative transfusion and 10 underwent non-emergent transfusion in the immedicte post-operative period. The authors analyzed each type of synostosis separately. For sagittal synostosis, preop hct ranged between 24%-37% with the postop(PACU) hct range 10%-37%. EBL for the sagittal group was 5-150 ml with a mean of 32 ml.
Ninety-seven patients were discharged on the first postoperative day. The authors report lower total cost for this procedure compared to cranial vault remodeling and conclude that their results are excellent with low morbidity. The authors describe their results as follows: "Most patients have achieved or are in the process of reaching normalization of their craniofacial deformities."
The commentary by Dr. Maugans, a pediatric neurosurgeon associated with the University of Vermont, notes that the paper from Missouri does indeed show that the technique described can be applied safely, with little OR time and low EBL. He notes that the authors of the paper do not rigorously define their reported good cosmetic results, however. Dr. Maugans, writing for the pediatricians who will likely be seeing these patients in their offices, also comments on the use of custom helmets for weeks to months and does not minimize the costs of time, effort etc involved in this process.
Commentary
This paper is reviewed simply as a FYI. Yet another surgery being done with an endoscope. I cannot draw on personal experience with surgeons who use this technique, so I found the balanced comments in Dr. Maugans commentary very helpful in evaluating this report of a new surgical technique. #include ./footer_include.iphtml