108. Ultra-early Endoscopic Synostectomy in Multi-sutural Syndromic and Nonsyndromic Craniosynostosis

Authors: Ken Maynard III, MD

Though endoscopic synostectomy has been well-established for single suture synostosis, few reports in the literature have described the efficacy of early endoscopic synostectomy in multi-sutural synostosis, conventionally carried out between 3 to 6 months of age. We describe our experience with ultra-early synostectomy in multi-sutural syndromic and nonsyndromic synostosis.Methods: A retrospective analysis of infants with multi-sutural synostosis operated at less than 8 weeks of age from 2011 to June 2021 was performed.
10 infants were operated with 12 total surgical procedures. Of these, 6 were < 2 weeks and 2 each between 3-4 weeks and 5-8 weeks of age. 4 had syndromic craniosynostosis (3 Crouzon’s, 1 Pfeiffer). All patients with syndromic synostosis had evidence of raised intracranial pressure on initial imaging. On the day of surgery, 6 infants weighed less than 3000 gm, another 3 were between 3000 to 4000 gm. In 2, the surgery was staged: one due to blood loss, and the other due to the positioning for the approach. The operative time was between 20-120 mins, and the blood loss between 20 -180 mL (average 72mL). 6 needed transfusions; 2 had durotomies which were repaired. All infants were fitted with cranial remodeling orthosis. During follow up, 4 underwent cranial expansion and remodeling with 2 of these requiring 2 craniotomies. One child is awaiting a second stage surgery, while another refused subsequent surgery. 3 children required VP shunt for hydrocephalus. The follow-up period varied between 6 months to 7 years.
Our preliminary data suggests ultra-early synostectomy can be undertaken safely in multi-sutural synostosis. A relatively longer operative time and intraoperative transfusion is commonly encountered. Early surgery provides cranial decompression allowing for adequate brain growth till the cranial expansion can be carried out in the later infancy especially in syndromic craniosynostosis.