Labuschagne Jason, Mutyaba Denis, Ouma John, Dewan Michael C
1Department of Neurosurgery, University of the Witwatersrand, Johannesburg.
2Department of Pediatric Neurosurgery, Nelson Mandela Children's Hospital, Johannesburg, South Africa; and.
J Neurosurg Pediatr. 2022 Oct 14;31(1):71-77. doi: 10.3171/2022.9.PEDS22227. Print 2023 Jan 1.
Early suturectomy with a rigid endoscope followed by orthotic cranial helmet therapy is an accepted treatment option for single-suture craniosynostosis. To the authors' knowledge, flexible endoscope-assisted suture release (FEASR) has not been previously described. Presented herein is their experience with FEASR for the treatment of isolated sagittal craniosynostosis.
A retrospective analysis of the health records of patients who had undergone FEASR between March 2018 and December 2020 was performed. Patients under the age of 6 months who had been diagnosed with isolated sagittal synostosis were considered eligible for FEASR. Exclusion criteria included syndromic synostosis or multiple-suture synostosis. The cephalic index, the primary measure of the cosmetic endpoint, was calculated at prespecified intervals: immediately preoperatively and 6 weeks and 12 months postoperatively. Parental satisfaction with the cosmetic outcome was determined throughout the clinical follow-up and documented according to a structured questionnaire for the first 12 months.
A total of 18 consecutive patients met the criteria for study inclusion. The mean patient age at the time of surgery was 3.4 months (range 2-6 months). All patients underwent a wide craniectomy with no need to convert to an open procedure. The mean craniectomy width was 3.61 cm. Estimated blood loss ranged from 5 to 30 ml. The mean operative time was 75 minutes. No intraoperative complications were observed. The average length of stay was 2.6 days. The mean cephalic index was 67.7 preoperatively, 77.1 at 6 weeks postoperatively, and 76.3 at 1 year postoperatively. The mean percentage change in the cephalic index from preoperatively to the 12-month follow-up was 10.44 (p < 0.001). The mean follow-up was 17 months (range 12-28 months). All parents were satisfied with the cosmetic outcome of the procedure. No patients developed symptoms of raised intracranial pressure (ICP) or needed invasive ICP monitoring during the follow-up period. No patients required reoperation.
In this modest single-hospital series, the authors demonstrated the feasibility of FEASR in treating sagittal synostosis with favorable cosmetic outcomes. The morbidity profile and resource utilization of the procedure appear similar to those of procedures conducted via traditional rigid endoscopy.
早期使用硬式内镜进行缝骨切除术，随后进行颅骨矫形头盔治疗，是单缝颅缝早闭公认的治疗选择。据作者所知，此前尚未描述过软性内镜辅助缝骨松解术（FEASR）。本文介绍了他们使用FEASR治疗孤立性矢状缝颅缝早闭的经验。
对2018年3月至2020年12月期间接受FEASR治疗的患者的健康记录进行回顾性分析。6个月以下被诊断为孤立性矢状缝早闭的患者被认为符合FEASR治疗条件。排除标准包括综合征性缝早闭或多缝缝早闭。在预定时间点计算头指数（美容终点的主要指标）：术前即刻、术后6周和12个月。在整个临床随访期间确定家长对美容效果的满意度，并根据结构化问卷记录前12个月的情况。
共有18例连续患者符合研究纳入标准。手术时患者的平均年龄为3.4个月（范围2 - 6个月）。所有患者均接受了广泛的颅骨切除术，无需转为开放手术。颅骨切除术的平均宽度为3.61 cm。估计失血量为5至30 ml。平均手术时间为75分钟。未观察到术中并发症。平均住院时间为2.6天。术前平均头指数为67.7，术后6周为77.1，术后1年为76.3。从术前到12个月随访时头指数的平均变化百分比为10.44（p < 0.）。平均随访时间为17个月（范围12 - 28个月）。所有家长对手术的美容效果均满意。随访期间无患者出现颅内压升高（ICP）症状或需要进行有创ICP监测。无患者需要再次手术。
在这个规模不大的单中心系列研究中，作者证明了FEASR治疗矢状缝早闭的可行性以及良好的美容效果。该手术的发病率和资源利用情况似乎与传统硬式内镜手术相似。
