Endoscopic technique for sagittal synostosis
Abstract
Purpose This study aimed to present a 16-year experience of treating sagittal synostosis with endoscopic-assisted techniques and postoperative cranial orthotic therapy. In 1996, we introduced the use of endoscopes for the management of sagittal synostosis in four young infants. During the subsequent years, we have treated a total of 256 patients with great success and long-term follow-up. Presented herein are the techniques and results of such clinical experience.Methods A total of 256 patients with sagittal synostosis have been treated between May 1996 and April 2012. There were 187 males and 69 females. Mean age at time of surgery was 3.9 months. A wide-vertex craniectomy with bilateral barrel stave osteotomies of the temporal and parietal bones using small scalp incisions and endoscopic viewing techniques was performed. Instruments have been developed to assist with the operation. All patients were placed in postoperative molding cranial orthosis.Results Mean estimated blood loss was 27 cc. Mean transfusion rate was 7 %. Mean surgical time was 57 min. Mean length of stay was 1.1 days. Using cephalic index (CI) as an anthropometric measurement to judge head shape, our results were classified as excellent (CI>80), good (CI 80-70), or poor (CI<70). A total of 87 % were classified as excellent, 9 % as good, and 4 % as poor.Conclusions Endoscopic-assisted management of sagittal synostosis is a safe, efficacious, and excellent option for treating this condition with long-lasting, superb results. It is associated with minimal morbidity and complications and improved results over traditional procedures.
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In the 16-year experience with 256 patients, blood loss was reduced to 27 ml and transfusion rate to 7%.
“Blood loss was reduced to an average of 27 ml and the transfusion rate to 7%.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [50]
The success rate of 87% remained similar over subsequent years.
“The very high success rate of 87% remained similar to subsequent years despite the change in CI guidelines”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [50]
ESC with barrel staves markedly decreased transfusion rates and mortality risk.
“In contrast, the introduction of ESC with barrel staves in the late 1990s by Jimenez and Barone, which was made possible by technological advances in image-guided surgery, instrumentation and neuroendoscopy, resulted in a reduction in blood loss to an average of 27 ml, markedly decreasing transfusion rates and mortality risk [9, 50].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [50]
Introduction of endoscopic strip craniectomy (ESC) with barrel staves in the late 1990s resulted in a reduction in blood loss to an average of 27 ml.
“In contrast, the introduction of ESC with barrel staves in the late 1990s by Jimenez and Barone, which was made possible by technological advances in image-guided surgery, instrumentation and neuroendoscopy, resulted in a reduction in blood loss to an average of 27 ml, markedly decreasing transfusion rates and mortality risk [9, 50].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [50]
After 16 years of using ESC with barrel staves, patients experienced shorter hospital stays compared with those who underwent open procedures.
“In addition to the reduced blood loss, after 16 years of using this method, patients experienced fewer transfusion and shorter hospital stays compared to those who underwent open procedures [15, 50].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [50]
After 16 years of using ESC with barrel staves, patients experienced fewer transfusions compared with those who underwent open procedures.
“In addition to the reduced blood loss, after 16 years of using this method, patients experienced fewer transfusion and shorter hospital stays compared to those who underwent open procedures [15, 50].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [50]
Endoscopic procedures have the advantage of requiring fewer skin incisions and less blood loss and are considered less invasive and more child-friendly.
“They have the advantage of requiring fewer skin incisions and less blood loss and are therefore considered less invasive and more child-friendly [64,65,66,67,68,69,70].”
From Isolated Sagittal Craniosynostosis: A Comprehensive Review (2024) · cites this paper as [67]
Two primary surgical approaches are utilized for treatment of craniosynostosis: the (flexible) endoscopic-assisted technique and the conventional open surgical approach, with the choice depending on individual surgical planning and case specifics.
“Two primary surgical approaches are utilized for the treatment of craniosynostosis: the (flexible) endoscopic-assisted technique and the conventional open surgical approach, with the choice depending on individual surgical planning and case specifics.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [50]
Endoscopic approaches are preferred in infants younger than 6 months, while open surgical techniques are typically used in older children.
“Endoscopic approaches are preferred in infants younger than 6 months, while open surgical techniques are typically used in older children [2, 50, 85].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [50]
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Shim, Y., Kim, S., Ko, J. M., Jeon, S., Kim, B. J., Jung, J. H., Lee, S., Kim, K. H., Lee, J. Y., & Phi, J. H. (2023) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000009835 · Cited by 3 · see citing works
Endoskopsko zdravljenje skafocefalije: prikaz primera in nove operacijske tehnike
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“The very high success rate of 87% remained similar to subsequent years despite the change in CI guidelines (87% of patients achieved a CI above 80, 9% a CI of 80–70 as good and 4% 70 as poor) [50].”
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Minimally invasive approaches to craniosynostosis
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Neighborhood Disadvantage Predicts Surgical Approach in Craniosynostosis Repair
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Craneosinostosis, una perspectiva pediátrica
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Endoscope-assisted treatment of scaphocephaly: report of a case and new surgical technique
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RETRACTED CHAPTER: Craniosynostosis: Endoscopically Versus Open Treatment
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RetractedTotal Cranial Vault Remodeling
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Craneosinostosis, una perspectiva pediátrica
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Non-syndromic craniosynostosis
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Chirurgia delle malformazioni craniofacciali: principi di base
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Cirugía de las malformaciones craneofaciales: principios básicos
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Cleft and Craniofacial Surgery
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History of Craniosynostosis Treatment
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Sagittal Suture Synostosis: Endoscopic Approach, Key Points for the Neurosurgeons
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- Authors
- Jimenez, D. F., & Barone, C. M.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- Corresponding author
- Jimenez, David F.
- Venue
- Child's Nervous System
- Published
- 2012-08-08
- Volume
- 28
- Issue
- 9
- Pages
- 1333-1339
- ISSN
- 0256-7040 (ISSN-L)
- 1433-0350
- OpenAlex
- W2035906713
- Cited by
- 102
- References
- 15
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 6 · 2023: 7 · 2022: 11 · 2021: 6 · 2020: 11 · 2019: 5 · 2018: 7 · 2017: 9 · 2016: 14 · 2015: 9 · 2014: 4 · 2013: 1 · 2012: 1
- FWCI
- 2.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Child s Nervous System (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Keywords
- sagittal synostosis, cephalic index, surgical outcomes, blood loss
- MeSH terms
- Anthropometry, Child, Preschool, Cranial Sutures, Craniosynostoses, Craniotomy, Endoscopy, Female, Humans, Infant, Longitudinal Studies, Male, Retrospective Studies, Treatment Outcome, Orthopedic Procedures, Plastic Surgery Procedures
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