Craniosynostosis

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Minimally Invasive Endoscopic Surgery for Craniosynostosis

In the simplest forms of single suture synostosis, in an infant younger than three or four months of age, minimally invasive endoscopic surgery may be an option. An endoscope is a long tube that fits through tiny incisions — an attached light and camera allow a surgeon to see inside the body without having to make a large incision.

Although the results are excellent with either corrective form of surgical treatment (traditional cranial vault vs. endoscopic repair), there are many advantages to the minimally invasive approach:

  • Shorter surgical time, including less time under anesthesia
  • Smaller incisions
  • Reduced risk of infection
  • Lower risk of blood loss and transfusion
  • Shorter hospital stay

The minimally invasive approach is best on younger infants (typically less than three or four months of age), since the extremely rapid brain growth of early infancy helps reposition the cranial bones after surgery. The soft, malleable skull of a very young baby also makes it easier for a surgeon to open the sutures using only small incisions. After three or four months of rapid growth, a baby’s skull starts to get thicker and less malleable, making endoscopic visualization more difficult. Although all patients are evaluated on a case-by-case basis, younger babies are generally considered better candidates for endoscopic surgery and older babies usually undergo the traditional cranial vault approach.  

After the Surgery

After an endoscopically assisted strip craniectomy, it is normal for a child to look swollen for the first few days. A baby may also be a little fussy with feeding after surgery, but this usually resolves quickly in the comfort of home.

After 10 to 14 days, we will see your child in our office for a post-operative follow-up visit.  At that point, the child will be custom fitted by an orthoptist for a cranial remodeling helmet, which will help reshape the skull. The helmet needs to be worn for 21 to 23 hours a day until the child reaches 9 to 12 months of age. (Although the baby’s head shape is corrected within the first three or four months after surgery, the skull shape can regress if helmet therapy is discontinued too early.)  Your child will have no special precautions or significant limitations on activities during this time.

The orthotist and neurosurgeon will work together to determine when helmet therapy should be stopped.  

Find out more about the multidisciplinary Craniofacial Program at the Weill Cornell Pediatric Brain and Spine Center, or use our online form to request an appointment for a consultation or second opinion.