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Endoscopic strip craniectomy is a surgery to remove a skull suture that has closed early in babies with certain types of single suture craniosynostosis. In North Austin, this surgery is performed by our pediatric neurosurgeon and a craniofacial plastic surgeon together. Unlike other types of craniosynostosis surgery, endoscopic strip craniectomy usually needs to be done before 4 months of age.
Through one or two small 1 ½” incisions on the top of the scalp, we use a thin lighted camera (endoscope) to remove the closed suture and make other cuts in the bone that allow the brain to expand. Unlike other craniosynostosis surgeries your baby will need to wear a special molding helmet for up to one year of age to guide the skull shape after the surgery. The cranial molding helmet needs to be adjusted around every two weeks. We partner with a company that specializes in molding helmets and usually has a branch close to your home.
- You will meet with an orthotist before surgery to learn how the cranial molding helmet works and how to use it.
- In North Austin both an experienced pediatric neurosurgeon and a craniofacial plastic surgeon perform the endoscopic strip craniectomy surgery. We feel this partnership is important to achieve the best result for your baby.
- The plastic surgeon starts by making the one or two small 1 ½” incisions on the top of the scalp and then gently separating the skin from the bone.
- The neurosurgeon then makes small holes in the skull or goes underneath the skull bone through the soft spot (anterior fontanelle) and uses a thin camera called an endoscope to separate the underneath of the skull bone from the covering of the brain (dura).
- The neurosurgeon removes the fused suture bone on the top of your baby’s head, leaving a soft spot that is 2” wide and 4” long. This soft spot will heal by itself over the next two months. We grind up the removed bone into small pieces and place it in the soft spot to help with healing.
- The plastic surgeon may then remove two triangles of bone on each side of the soft spot down the side of the skull. This helps the bone hinge open and increase the width of the head.
- The plastic surgeon stitches the incisions closed with dissolving sutures.
- After the surgery, most babies spend 1 night in the intensive care unit (ICU). On the second night they are in a regular hospital room. Some babies are able to go home the day after surgery. Total time in the hospital is 1-3 days
- Around 10 days after surgery, you will return to the orthotist clinic. They will do a surface scan of your baby’s head and create a cranial molding helmet designed specifically for your baby. It usually takes one week to make the helmet.
- We will see you in the surgery clinic for a post-operative visit and to check the helmet fitting around 3 weeks after the surgery. We are always available to ask any questions or to see your baby for any reason after the surgery. The next scheduled visit will be after your baby outgrows their first molding helmet.
- Your baby will need to wear the helmet for 23 hours a day for the molding to work.
- Babies wear the helmet for 3 to 6 months. Some babies need a new helmet after about 6 months if they outgrow their first helmet and still need more treatment.
- We offer different types of surgery for craniosynostosis because we want parents to be able to choose the option that works the best for their baby and their family. Our team is experienced and comfortable performing all the procedures. During your first visit we will discuss which techniques we recommend for your child and help you make your decision.
- Endoscopic strip craniectomy is a treatment option only for babies who are 4 months or younger. After this age, the head is not growing as fast, so the helmet is not likely to work as well. We offer other techniques that give the same long-term result if your child is older than 4 months.
- For certain types of craniosynostosis we can place small springs in the bone cuts in the skull during the surgery. This is called spring cranioplasty. The springs will slowly expand the skull after surgery. Compared to endoscopic cranial strip surgery, a cranial molding helmet is not needed with spring cranioplasty, but your baby will need to return to the operating room after the skull has expanded for the surgeon to remove the springs. Spring cranioplasty can be performed until 6 months of age.
- Open cranial vault remodeling is a surgical treatment that can be performed at any age and for any type of craniosynostosis. In this technique the surgeons use a zig-zag incision that goes from temple to temple called a “coronal scar”. This allows the surgeons to see all the skull bone directly during the surgery. The neurosurgeon starts by carefully removes the bone from the covering of the brain. The craniofacial plastic surgeon then uses carpentry techniques to rebuild the part of the skull affected by craniosynostosis into its new shape. You can see a comparison of open cranial vault remodeling with endoscopic strip craniectomy in the table below:
OPEN CRANIAL REMODELING | ENDOSCOPIC STRIP CRANIECTOMY |
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- If a child is less than 4 months old, we can use endoscopic strip craniectomy to treat their craniosynostosis
- The most common types of suture fusion we use endoscopic strip craniectomy to treat are sagittal synostosis, lambdoid synostosis, and metopic synostosis
- Endoscopic strip craniectomy can also be used to treat unilateral coronal synostosis but in some cases there is still some head flatness as the child grows up that needs additional surgery to treat.
- We usually recommend a different technique to treat complex craniofacial syndromes such as open cranial vault remodeling or cranial vault distraction.
- Your surgeons will discuss and compare each surgical technique that can be used to treat your baby with craniosynostosis so you can find the one that works best for your family. All techniques that we use are designed to give a safe and high quality result.
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