Endoscopic Strip Craniectomy
An endoscopic strip craniectomy is a surgery to remove a fused suture in a baby with craniosynostosis. An endoscopic strip craniectomy is different from the open remodeling technique because your baby wears a helmet to mold their head to a more normal shape in the months after surgery. The open technique uses resorbable plates and screws to reshape the head during the surgery instead. Open surgery requires a larger cut (incision) in the scalp, whereas endoscopic strip craniectomy uses two smaller incisions and an endoscope camera for the surgeon to perform the procedure. Endoscopic strip craniectomy can often be performed without the need for a blood transfusion.
Endoscopic strip craniectomy may be an option for babies with sagittal, lambdoid, metopic or unilateral (one-sided) coronal craniosynostosis, depending on their age.
An experienced craniofacial plastic surgeon and a neurosurgeon work as a team in the operating room from the beginning to the end of the case, performing all of the surgery. The craniofacial plastic surgeon makes two small incisions in the top of your baby’s head to separate the skin and other soft tissue from the bone underneath.
Next the neurosurgeon makes small holes in the skull or enters the skull through your baby’s soft spot (fontanelle). The neurosurgeon uses an endoscope to separate the dura mater from the inside of the skull to free the bone. Then the neurosurgeon cuts around the fused suture and takes out this strip of bone.
With the fused suture gone, the neurosurgeon separates more of the dura mater from the inside of the skull, moving toward the ears. Then the plastic surgeon removes two wedges of bone from each side of the head.
The wedges are cut into pieces and then put back into places where bone was removed, starting from the top, to help in healing. The incisions are closed with resorbing sutures. The removed pieces of skull bone allow your baby’s skull to expand as the brain grows and to be molded into a more normal and functional shape with a removable helmet. Over time, the pieces of bone will grow together to protect their brain.
After surgery, most babies spend one night in the intensive care unit and one night in a regular hospital room before going home.
About two weeks after surgery, your baby will wear a helmet to put gentle pressure on their skull. This molds their head to a more normal shape as their skull heals and grows. It also keeps the suture from fusing again too soon.
This part of the treatment is called helmet therapy or cranial orthosis. In the endoscopic technique, both surgeons are important but the experienced orthotist who creates and fits the molding helmet is also essential. Our two orthotists who perform the post-operative molding are very experienced with helmet technology.
Before surgery, you will meet with an orthotist who will explain how the helmet works and how to use it.
About 10 days after surgery, your baby returns to see the orthotist. This person does a laser scan to create a picture of your baby’s head to make a custom helmet.
The helmet is delivered within about a week. We check to make sure it fits well. Then we see your baby for follow-up visits every one to two weeks to check that the helmet is molding their head the way we want.
Babies wear the helmet for at least three months and sometimes for up to a year. Some babies need a new helmet made after about six months to keep up with the growth of their head. Your baby will wear the helmet all the time, except during bathing.