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Minimally Invasive Endoscopic Assisted Craniosynostosis Surgery

(Feb 1, 2009)

In the Division of Pediatric Neurosurgery at Columbia University Medical Center and the Morgan Stanley Children's Hospital of NewYork-Presbyterian, recent advances have made surgery for children with craniosynostosis shorter and safer. The minimally invasive, endoscopic-assisted craniosynostosis surgery utilizes a small camera to assist with removal of the abnormal bone that causes skull deformity through one or two one-inch incisions.

The surgery is performed in one to two hours, children rarely need a blood transfusion, and they typically go home the next day. This is in striking contrast to the traditional approaches used to treat craniosynostosis at nearly all other centers in the Northeast. Traditional approaches typically require a large incision across the top of the head from ear to ear, removal of a much larger amount of bone, and then reshaping and replacement of the removed bone. This surgical approach usually requires 6-8 hours, causes much more pain and swelling, requires a blood transfusion, and children remain in the hospital for about 4-7 days.

The key for success using the minimally invasive endoscopic-assisted approach is to intervene early, when the bone is thin. Removal of the prematurely closed suture (the abnormal bone) when the child is between two and six months of age allows the skull to develop a more normal shape as the child grows. The use of a helmet for 6-12 months after surgery helps facilitate this bone remodeling.

Craniosynostosis is a congenital problem (i.e., children are born with it) that typically affects about 1 in 5,000 children. Although the cause is usually unknown, the result is the premature closure or fusion of one of the cranial sutures, or growth plates, of the skull. When this occurs, stereotypical skull and facial deformities can occur. Unless surgically treated, these deformities tend to worsen with time, particularly over the first year of life.

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