Immediate Cranial Vault Reconstruction With Bioresorbable Plates Following Endoscopically Assisted Sagittal Synostectomy

Minimally invasive, endoscopically assisted strip craniectomy has been successfully used for early treatment of craniosynostosis. Building on the introduction of the endoscopic technique by Vicari 2 and combining strip synostectomy with postoperative helmet molding , Barone and Jimenez have reported excellent results in patients with sagittal synostosis. By operating as early as possible, these authors have produced comparable results to standard cranial vault reshaping with less blood loss, shorter operating times and earlier discharge from the hospital. The disadvantage of their procedure is the prolonged need for postoperative helmet therapy. Vicari in a recent update of his technique claims similar results can be achieved without using a postoperative helmet. However, in our opinion, in more severe cases of scaphocephaly, complete correction may not be accomplished with synostectomy alone. Herein, we describe an improvement in the endoscopic technique that permits more definitive head shape changes and immediate reconstruction of the scaphocephalic deformity. By utilizing extensive cranial osteotomies and wedge ostectomies in concert with rigid fixation using bioresorbable devices (MacroPore, Inc., San Diego, CA), immediate cranial reconstruction can be achieved in selected patients with sagittal synostosis who undergo the endoscopic assisted technique.