Department of Surgery, Weill Cornell Medical College, New York, NY.
Columbia College, Columbia University, New York, NY.
J Craniofac Surg. 2021 May 1;32(3):936-939. doi: 10.1097/SCS.0000000000007312.
The goal of endoscopic treatment for craniosynostosis is to remove the fused suture and achieve calvarial remodeling with external orthosis. To reduce the need for secondary surgery and to minimize blood loss, instruments that maximize bone removal while minimizing blood loss and risk of dural injury are evolving. The authors therefore assess the safety and efficacy of the Sonopet Ultrasonic Bone Aspirator (UBA) (Stryker, Kalamazoo, MI) for endoscopic suturectomy compared to traditional instrumentation at our institution.
Retrospective chart review of consecutive endoscopic suturectomies performed from 2011 to 2019 at Weill Cornell Medical Center was conducted, including demographics, cephalic index, surgical indications, operative time, cosmetic and functional results, complications, estimated blood loss (EBL), re-operation rate, length of stay, and length of helmet therapy. These variables were then compared between the Sonopet and non-Sonopet cohorts.
Of the 60 patients who underwent endoscopic suturectomy, 16 cases (26.7%) utilized the Sonopet. Mean operative time was 2.8 ± 0.4 hours in the Sonopet group, compared to 3.2 ± 1.2 hours (P = 0.05) without the Sonopet. EBL was 17.8 ± 23.9 cc versus 34.7 ± 75.5 cc (P = 0.20) with versus without the Sonopet respectively. Length of stay and duration of helmet therapy were similar in both groups, ranging from 1 to 3 days (P = 0.68) and 7.25 to 12 months (P = 0.30) respectively. There were no reoperations in the Sonopet group with a mean follow up of 9.18 months. There were 3 reoperations in the non-Sonopet group with a mean follow up of 11.3 months. Among the cases utilizing the Sonopet, 13 (81%) were metopic and three (19%) were coronal synostoses. Of the non-Sonopet cases, 27 (61%) were sagittal, 8 (18%) were metopic, 7 (16%) were coronal, and 2 (5%) were lambdoid synostoses.
The use of the Sonopet resulted in a mean decrease in operative time at our institution (P = 0.18). Lower EBL and reoperation rates with comparable LOS and helmet therapy duration were also seen. This modality should be considered a safe and effective adjunct in appropriate endoscopic craniosynostosis cases.
颅缝早闭内镜治疗的目的是去除融合的缝线，并通过外部矫形器实现颅骨重塑。为了减少二次手术的需要，并最大限度地减少失血量和硬脑膜损伤的风险，正在开发最大限度地去除骨量而又最大限度地减少失血量和硬脑膜损伤风险的器械。因此，作者评估了 Sonopet 超声骨吸引器（UBA）（Stryker，密歇根州卡拉马祖）与我们机构的传统器械相比，用于内镜缝合切除术的安全性和有效性。
对 2011 年至 2019 年在威尔康奈尔医学中心连续进行的内镜缝合切除术进行了回顾性图表审查，包括人口统计学、头指数、手术指征、手术时间、美容和功能结果、并发症、估计失血量（EBL）、再手术率、住院时间和头盔治疗时间。然后将这些变量与 Sonopet 和非 Sonopet 组进行比较。
在 60 例接受内镜缝合切除术的患者中，有 16 例（26.7%）使用了 Sonopet。Sonopet 组的平均手术时间为 2.8±0.4 小时，而无 Sonopet 组为 3.2±1.2 小时（P=0.05）。Sonopet 组的 EBL 为 17.8±23.9 cc，而无 Sonopet 组为 34.7±75.5 cc（P=0.20）。两组的住院时间和头盔治疗时间相似，范围为 1 至 3 天（P=0.68）和 7.25 至 12 个月（P=0.30）。Sonopet 组无再手术，平均随访 9.18 个月。非 Sonopet 组有 3 例再手术，平均随访 11.3 个月。在使用 Sonopet 的病例中，13 例（81%）为额缝早闭，3 例（19%）为冠状缝早闭。在非 Sonopet 病例中，27 例（61%）为矢状缝早闭，8 例（18%）为额缝早闭，7 例（16%）为冠状缝早闭，2 例（5%）为人字缝早闭。
在我们机构，Sonopet 的使用导致手术时间平均缩短（P=0.18）。较低的 EBL 和再手术率，以及相似的 LOS 和头盔治疗持续时间，也得到了证实。在适当的内镜颅缝早闭病例中，这种方法应被视为一种安全有效的辅助手段。
