Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis
Abstract
Object Endoscopic techniques were introduced 7 years ago for the surgical management of patients with sagittal synostosis. In this study of 139 patients with sagittal synostosis, the authors assessed the efficacy, safety, complications, and outcomes after performing endoscopy-assisted wide-vertex craniectomies with bitemporal and biparietal barrel stave osteotomies. Methods The sample population consisted of a total of 99 boys and 40 girls who ranged in age from 0.4 to 9.2 months (mean 3.6 months). Two small incisions were made near the lambda and vertex. Using endoscopic visualization, wide-vertex craniectomies with bilateral temporal and parietal barrel stave osteotomies were performed. Postoperative treatment included custom-made surlyn cranial orthotic devices for cranial reshaping and maintenance. The mean craniectomy width was 5.4 cm and the length was 10 cm. The overall blood transfusion rate was 9% (two intraoperative and 12 postoperative transfusions). The mean estimated blood loss was 29 ml (range 5-150 ml). The mean preoperative hematocrit was 32%, whereas the postoperative level was 27%. One hundred thirty-two patients were discharged the morning following surgery. The majority of patients did not experience facial swelling, and none suffered postoperative fevers. Anthropometric cephalic index measurements indicated that excellent results were obtained in 87% of the patients (cephalic index > 75); good results in 8.7% (cephalic index 70-75); and poor results in 4.…
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Endoscopic procedures are particularly advantageous when performed early in life.
“Endoscopic procedures are particularly advantageous when performed early in life, as they involve smaller incisions and facilitate quicker recovery [12–15].”
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 [15]
Endoscopic surgery demonstrates a significantly lower mortality rate compared to open techniques, attributed to its minimally invasive nature and reduced surgical trauma.
“Endoscopic surgery demonstrates a significantly lower mortality rate compared to open techniques, attributed to its minimally invasive nature and reduced surgical trauma.”
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 [15]
In the 2004 publication, 87% of patients had excellent outcomes with CI >75, 8.7% good (70-75), 4.3% poor (<70).
“The results showed that 87% of patients had excellent outcomes with a cephalic index of over 75, 8.7% had good outcomes between 70 and 75 and 4.3% had poor outcomes (< 70) had poor outcomes.”
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 [15]
The mortality rate with the endoscopic technique was lower than with traditional reconstruction methods such as full CVR, and no serious complications occurred.
“The mortality rate was lower than with traditional reconstruction methods such as full CVR, and no serious complications occurred [15].”
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 [15]
In the 2004 publication, 9% of 139 patients required blood transfusions, mean blood loss was 29 ml.
“A total of 9% (two intraoperative, 12 postoperative) required blood transfusions, the mean blood loss was 29 ml.”
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 [15]
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 [15]
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 [15]
Early diagnosis enables appropriate planning and intervention and supports normal growth of the skull and brain in the best possible way.
“Early diagnosis enables appropriate planning and intervention, also to support the normal growth of the skull and brain in the best possible way, but also as the condition can be treated minimally invasively in the first months of life with reduced mortality [15, 88].”
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 [15]
The condition can be treated minimally invasively in the first months of life with reduced mortality.
“Early diagnosis enables appropriate planning and intervention, also to support the normal growth of the skull and brain in the best possible way, but also as the condition can be treated minimally invasively in the first months of life with reduced mortality [15, 88].”
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 [15]
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“Early diagnosis enables appropriate planning and intervention, also to support the normal growth of the skull and brain in the best possible way, but also as the condition can be treated minimally invasively in the first months of life with reduced mortality [15, 88].”
Influential
- Authors
- Jimenez, D. F., Barone, C. M., McGee, M. E., Cartwright, C. C., & Baker, C. L.
- Affiliations
- University of Missouri Health System (US)
- University of Missouri (US)
- Venue
- Journal of Neurosurgery: Pediatrics
- Published
- 2004-05
- Volume
- 100
- Issue
- 5
- Pages
- 407-417
- ISSN
- 1933-0707 (ISSN-L)
- OpenAlex
- W2122255052
- Cited by
- 185
- References
- 2
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 9 · 2023: 13 · 2022: 13 · 2021: 11 · 2020: 7 · 2019: 6 · 2018: 10 · 2017: 13 · 2016: 8 · 2015: 10 · 2014: 8 · 2013: 5 · 2012: 15
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Neurosurgery Pediatrics (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, craniosynostosis, cranial vault reconstruction, cranial orthosis, cephalic index, surgical complications, blood loss
- MeSH terms
- Cranial Sutures, Craniosynostoses, Craniotomy, Endoscopy, Female, Head Protective Devices, Humans, Infant, Infant, Newborn, Male, Osteotomy, Postoperative Care, Blood Loss, Surgical, Treatment Outcome
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