Endoscopic Treatment of Craniosynostosis Our Approach May 8, 1997 – March 30, 2005 Constance M....
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Transcript of Endoscopic Treatment of Craniosynostosis Our Approach May 8, 1997 – March 30, 2005 Constance M....
Endoscopic Endoscopic Treatment of Treatment of
Craniosynostosis Craniosynostosis Our ApproachOur ApproachMay 8, 1997 – May 8, 1997 –
March 30, 2005March 30, 2005Constance M. Barone, M.D.Constance M. Barone, M.D.
David F. Jimenez, M.D.David F. Jimenez, M.D.
University of Texas Health Science CenterUniversity of Texas Health Science CenterSan Antonio, TexasSan Antonio, Texas
All SuturesAll Sutures
Sagittal 108 M + 39 F = 147Sagittal 108 M + 39 F = 147 Coronal 30 M + 37 F = 67Coronal 30 M + 37 F = 67 Metopic 41M + 18 F = 59Metopic 41M + 18 F = 59 Lambdoid 7M + 3F = 10Lambdoid 7M + 3F = 10
Total number of patients = 283Total number of patients = 283 Total number of sutures = 300Total number of sutures = 300
Average Age of Pts. Average Age of Pts. (Months)(Months)
Sagittal Sagittal 3.6 months3.6 months CoronalCoronal 3.8 months3.8 months MetopicMetopic 4.2 months4.2 months LambdoidLambdoid 5.2 months5.2 months Average of allAverage of all 4.2 4.2
monthsmonths
Average Weight (kg)Average Weight (kg)
Avg Sagittal Avg Sagittal 6.30 6.30 Avg CoronalAvg Coronal 6.38 6.38 Avg MetopicAvg Metopic 6.48 6.48 Avg LambdoidAvg Lambdoid 7.39 7.39
Avg all Avg all 6.636.63
Estimated Blood Loss Estimated Blood Loss (cc)(cc)
Sagittal Sagittal 28.2 (avg)28.2 (avg) CoronalCoronal 19.5 (avg)19.5 (avg) MetopicMetopic 33.4 (avg)33.4 (avg) LambdoidLambdoid 23.0 (avg)23.0 (avg)
Overall AverageOverall Average 26.0cc26.0cc
Craniectomy Size (cm)Craniectomy Size (cm)
Width x Width x LengthLength
Average Sagittal 5.5 cm x 10.4Average Sagittal 5.5 cm x 10.4 Average Coronal 0.68 x 10.6Average Coronal 0.68 x 10.6 Average MetopicAverage Metopic 0.71 x 9.80.71 x 9.8 Average LambdoidAverage Lambdoid 1.6 x 7.51.6 x 7.5
Average of all surgeries 2.1 x 9.6Average of all surgeries 2.1 x 9.6
Length of Stay (days)Length of Stay (days)
Avg Sagittal Avg Sagittal 1.071.07 Avg CoronalAvg Coronal 1.031.03 Avg MetopicAvg Metopic 1.001.00 Avg LambdoidAvg Lambdoid 1.001.00
Avg allAvg all 1.021.02
Operative Time Operative Time (minutes)(minutes)
SagittalSagittal MetopicMetopicCoronalCoronal
57 (mean)57 (mean) 5757 5656
25-15025-150 30-9030-9025-6025-60
Blood TransfusionsBlood Transfusions
Sagittal Metopic Sagittal Metopic CoronalCoronal
Intraop 2 (1.4%) 0 0Intraop 2 (1.4%) 0 0
Postop 12 (8.5%) 4 (3.4%) 0Postop 12 (8.5%) 4 (3.4%) 0
Total 14 (10%) 4 (3.4%) Total 14 (10%) 4 (3.4%) 00
ResultsResults
Sagittal Metopic CoronalSagittal Metopic Coronal Incomplete ossification 0 2 3Incomplete ossification 0 2 3 Abnl ossification 4 0 0Abnl ossification 4 0 0 Dural Tear 1 0 0Dural Tear 1 0 0 Coagulopathies 1 0 0Coagulopathies 1 0 0 CSF leak 0 2 0CSF leak 0 2 0 Venous air embolism 0 2 (II) 0Venous air embolism 0 2 (II) 0 VP shunt 3 0 0VP shunt 3 0 0
ResultsResults
Hematomas, Infections, Seizures, Hematomas, Infections, Seizures, Convert to Open, Reoperation, Convert to Open, Reoperation,
Intrparenchymal Injury, Intrparenchymal Injury, Neurologic Injuries, Ocular Neurologic Injuries, Ocular
Injuries, Injury to Sagittal Sinus Injuries, Injury to Sagittal Sinus = 0= 0
Methods & MaterialsMethods & Materials
SAGITTAL SUTURESAGITTAL SUTURE
Pre Op Immediate Post-Op
Sagittal ResultsSagittal Results
Cephalic IndexCephalic Index• Excellent: Excellent: > 75 > 75• Good Good 70 -7570 -75• PoorPoor < 70 < 70
• Mean Preop CI: 67.4 Mean Preop CI: 67.4 (61 – 90)(61 – 90)
Sagittal ResultsSagittal Results
• Excellent Excellent 87% 87%
• Good Good 8.7% 8.7%
• Poor Poor 4.3%4.3%
ENDOSCOPIC SURGERY ENDOSCOPIC SURGERY RESULTSRESULTS
BEFORE AFTER
BEFORE AFTER
1 YEAR
3 YEARS
BEFORE AFTER
METOPICMETOPIC
4 MONTHS POSTPRE - OP
PRE - OP 1 YEAR POST
1 YEAR POSTPRE - OP
preop preop 4 years 4 years
CORONALCORONAL
CORONAL SUTURECORONAL SUTURE
CORONAL SUTURECORONAL SUTURE
SPHENOID’S LESSER WINGFRONTAL DURA TEMPORAL DURA
2 month female2 month female
CLINICAL CASESCLINICAL CASES
Patient: Patient: TMTM Age: Age: 2 months2 months Sutural Sutural
Involvement:Involvement: Left CoronalLeft Coronal SagittalSagittal Left Lambdoid Left Lambdoid
Pre op3 years
Pre op 2 yrs
Pre op 2 yrs
CLINICAL CASESCLINICAL CASES
Patient: Patient: NMNM Age: Age: 2 months2 months Sutural Sutural
Involvement:Involvement: RightRight Coronal Coronal Metopic Metopic
MULTIPLE SUTURESMULTIPLE SUTURES
Pre op 1 yr 3 yrs