SLCH Surgeons Perform 100th Endoscopic Craniosynostosis Repair
Since October 2006, Matthew Smyth, MD, St. Louis Children’s Hospital pediatric neurosurgeon, has partnered with the hospital’s craniofacial plastic surgeons to perform 100 endoscopic craniosynostosis repairs. This minimally-invasive procedure has become the preferred method of correcting all types of craniosynostosis in babies 6 months of age and younger.
“Our five years of experience has shown that the outcomes for babies undergoing endoscopic repair of this condition are comparable to if not better than those undergoing the open surgery technique,” says Dr. Smyth. He and his colleagues recently published their findings in an article titled “Endoscopically Assisted Vs. Open Repair for Sagittal Craniosynostosis: The St. Louis Children’s Hospital Experience,” which appeared in the Journal of Neurosurgery: Pediatrics. “The many advantages of the endoscopic repair to our young patients make this technique particularly appealing to parents.”
Open surgery for craniosynostosis requires an incision over the top of the head from ear to ear, which allows surgeons to remove the deformed bone, reshape it, and then replace and secure it with dissolving plates and screws. The procedure usually requires a blood transfusion and a three to six day hospital stay with an overnight in the PICU.
In contrast, during endoscopic craniosynostosis repair surgeons utilize an endoscope through two small incisions measuring about 1.5 inches each at the top of the head. A segment of bone is removed near the fused bone and in a few other places, releasing the fusion. No plating or reshaping is performed. Instead, in the first week after surgery a customized molding helmet is made, which patients wear 23 hours a day until they reach 1 year of age.
“Operative time with the endoscopic procedure is one and a half hours or less compared to about five hours for open surgery,” says Dr. Smyth. “The decreased blood loss means most patients do not need a blood transfusion, their hospital stay is one or two days, their discomfort and swelling is greatly reduced, and the scars are much less noticeable.”
The success of the endoscopic craniosynostosis repair program at Children’s Hospital is a result of the close collaboration between neurosurgery and plastic and reconstructive surgery. “Dr. Alex Kane and I began the initial partnership, and it continues with Dr. Albert Woo, chief of pediatric plastic surgery, and his colleague, Dr. Kamlesh Patel,” he says. “The procedure requires four hands working simultaneously, where all four hands know what the next hand is going to do in terms of maneuvering the scope, the instruments and light source. The craniofacial and neurological surgeons work together to provide patients with an easier surgery, faster recovery and favorable overall outcome.”
