ENDOSCOPIC ASSISTED KEY HOLE SUTURECTOMY IN CRANIOSYNOSTOSIS: A CASE REPORT

Dr. Ali Al Mashani, Dr. Mahmood Al Hattali, *Dr. Neeraj Salhotra, Dr. Fahad Al Kheder, Dr. Ahmed Al Wadee, Dr. Kauthar Al Zakwani, Dr. Afaf Al Hatmi, Dr. Hotchand Maheshwari and Dhairya Mathur

ABSTRACT

Endoscopic assisted key hole suturectomy is for children with a condition called craniosynostosis, which is the early closure of sutures of the skull. The skull is made up of different plates, and in babies, these plates are separate. Sometimes a baby is born with one or more of these sutures closed. Craniosynostosis can cause a problem with the growth of the skull, and may cause problems with the pressure inside the brain. Children with craniosynostosis need surgical treatment. Traditionally, craniosynostosis operations are usually quite large and leave a large scar at the top of the head. The operation involves taking a big piece of the bone off and putting it back into a different position. We often call these remodeling operations; they are established and very good, but as you can imagine they are quite big, they take many hours, involve a big scar, long hospital stay and usually some blood loss.So there has been an increasing interest in looking at a surgery that’s less invasive, with smaller scars and shorter operating times. This actually has led to re-exploring an operation which is the idea of doing a suturectomey. Surgeon would remove a piece of fused bone along the suture, but it became apparent that this would just heal up, and the skull wouldn’t change shape. So Surgeons continue to do remodeling operations. However, what has now become apparent is that if you take out a piece of bone, alongside a mechanical device to put pressure on the skull that will cause the skull to grow normally. One of the ways this is done is by using springs, which is an internal device to gradually open up and widen the skull, and it is very successful. Another option is to use a helmet. Nowadays we can do an endoscopic operation (keyhole surgery with a very small incision of 2cm long) to remove a piece of bone. This type of operation takes less than an hour, with very rarely need for a blood transfusion, and only one night in hospital. This is then followed up with postoperative helmet therapy a week later. This uses a helmet specifically made for the child that encourages the skull to grow in the shape you want it to. The helmet needs to be worn for 10 months for 23 hours a day and children tolerate this very well. Here we present an infant with craniosynostosis treated by endoscopic suturectomy.

Keywords: Endoscopic, Sutrectomy.