Endoscopic Suturectomy for Non-syndromic Craniosynostosis Followed by Helmet Therapy– Early Experience in a Limited Resource Setup

Introduction: : In this paper, we report our single-center experience with endoscopic strip craniectomy followed by molding helmet therapy with specific focus on the various surgical techniques for endoscopy, feasibility, safety and early surgical

Methods: This prospective case series was conducted at neurosurgery department, Lady reading hospital, Peshawar from July 2020 to august 2022. 26 consecutive non-syndromic patients with single or multiple suture synostosis who were less than 6 months old at the time of endoscopic surgery were included.
All surgeries were performed with zero and 30 degree rigid neuro-endoscope without any additional specialized instruments. Each procedure was performed with one or two 3-cm skin incisions depending on the location and number of sutures and extent of craniectomy. Craniectomies were performed with different methods including rongeurs, mayo scissors and giggly saw in different cases.

Results: There were 19 male and 7 females, with an age range of 1.3 to 5.5 months. Cases included 14 sagittal, 6 uni-coronal, 3 metopic and 3 multiple suture synostoses. Mean time on the operative table (including anesthesia) was 102 minutes. Only 1 patient received blood transfusion, two had minor dural tears, one had post operative hematoma and two patients had superficial infections. No sinus or brain injury was encountered. Only 4 patients were kept in hospital for more than one day. All patients are currently using helmet therapy and no revision has yet been done.

Conclusion :: Endoscopic suturectomy is safe and effective treatment for craniosynostosis in patients less than 6 months age with reduced complications when performed in a low resource setup