Ultra-early synostectomy and cranial remodeling orthoses in the management of craniosynostoses
Open accessAbstract
OBJECTIVE: The advent of endoscopic synostectomy has enabled early surgery for infants with craniosynostosis. Even though diagnosis is often made at birth, endoscopic synostectomy has traditionally been delayed until the infant is 3 months of age. There have been very few published reports of this procedure being performed in the early neonatal period. The authors discuss their experience with ultra-early endoscopic synostectomy, defined as an operation for infants aged 8 weeks or younger. METHODS: A retrospective analysis of infants who underwent operations at or before 8 weeks of age between 2011 and 2020 was done. RESULTS: Twenty-five infants underwent operations: 11 were 2 weeks of age or younger, 8 were between 3 and 4 weeks of age, and 6 were between 5 and 8 weeks of age. The infants weighed between 2.25 and 4.8 kg. Eighteen had single-suture synostosis, and 7 had multiple sutures involved. Of these 7, 4 had syndromic craniosynostosis. The average operative time was 35 minutes, and it was less than 40 minutes in 19 cases. The estimated operative blood loss was 25 ml or less in 19 cases; 5 infants required an intraoperative blood transfusion. In 1 child with syndromic multisuture craniosynostosis, the surgery was staged due to blood loss. Two children experienced complications related to the procedure: one had an incidental durotomy with skin infection, and the other had postoperative kernicterus. All infants were fitted for cranial remodeling orthoses following surgery. Three of the 25 infants required reoperations, with 2 patients with syndromic craniosynostosis needing repeat surgery for cranial volume expansion and cosmetic appearance. Another child with syndromic craniosynostosis is awaiting cranial expansion surgery. Follow-up varied between 6 months and 8 years. CONCLUSIONS: The data show that ultra-early synostectomy is safe and not associated with increased complications compared with surgery performed between 3 and 6 months of age. Infants with multisuture synostosis had increased operative time, required blood transfusion, and were more likely to require a second operation.
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Ultra-early synostectomy in combination with helmet therapy has benefits and potential to optimise cranial remodeling outcomes.
“Mohanty et al. further highlighted the benefits of ultra-early synostectomy in combination with helmet therapy, emphasising its potential to optimise cranial remodeling outcomes [76].”
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 [76]
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- Authors
- Mohanty, A., Frank, T. S., Mohamed, S., Godwin, K., & Malkani, G. G.
- Affiliations
- The University of Texas Medical Branch at Galveston (US)
- Pediatrics and Genetics (US)
- Pediatrics, HCA Houston Health Care Clear Lake, Webster, Texas
- Corresponding author
- Mohanty, Aaron
- Venue
- Neurosurgical Focus
- Published
- 2021-04
- Volume
- 50
- Issue
- 4
- Pages
- E8
- ISSN
- 1092-0684 (ISSN-L)
- OpenAlex
- W3145957993
- Cited by
- 14
- References
- 19
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 1 · 2021: 2
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Neurosurgical FOCUS (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
- craniosynostosis, neonatal surgery, syndromic craniosynostosis, operative blood loss, intraoperative blood transfusion, postoperative complications, reoperation
- MeSH terms
- Child, Craniosynostoses, Humans, Infant, Infant, Newborn, Orthotic Devices, Retrospective Studies, Skull, Treatment Outcome
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