What is endoscopic strip craniectomy?
An endoscopic strip craniectomy is a surgery to remove a fused suture in a baby with craniosynostosis. This is a minimally invasive procedure to allow your baby’s head to expand as their brain grows. It may be an option for babies with sagittal or lambdoid craniosynostosis.
An endoscopic strip craniectomy is different from open surgery because your baby wears a helmet to mold their head to a more normal shape after surgery. Open surgery requires a larger cut (incision), along with plates and screws to hold the new head shape.
How does it work?
A plastic surgeon and a neurosurgeon work as a team to perform the surgery.
The 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 wedges of bone from the sides of the head.
The wedges are cut into pieces and then put back into places where bone was removed. This way your baby’s skull can expand and be molded with the helmet. Over time the pieces of bone will grow together to protect their brain.
The incisions are closed after the surgery is complete. 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 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.
Before surgery, you will meet with an orthotist, who makes and fits helmets. They 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 molding their head. Your baby will wear the helmet all the time, except during bathing.
Who needs endoscopic strip craniectomy?
An endoscopic strip craniectomy is only a treatment option for babies who:
- Have a fused sagittal or lambdoid suture.
- Are 4 months old or younger. After this age, the head is not growing as fast, so the helmet is not likely to work as well.
Even if your baby fits both of these, they can have open surgery instead. The open method also works well to reshape the head. Some of the benefits and risks differ. The next section explains more about how the two options compare.
For babies who are not a good fit for an endoscopic strip craniectomy, we offer open surgery. Research and experience are not clear if an endoscopic strip craniectomy works as well as open surgery for these babies.
What are the benefits of endoscopic strip craniectomy?
Results suggest that endoscopic strip craniectomy followed by a helmet works as well as open surgery for babies up to age 4 months with a fused sagittal or lambdoid suture.
The benefits of the endoscopic method may include:
- Smaller incisions and less scarring
- Less bleeding, so less chance of a blood transfusion
- Less time in surgery
- Shorter hospital stay
The main benefit of the open method is that your baby does not need to wear a helmet after surgery and does not need to return for many visits to check the helmet fit. In open surgery, surgeons remove the fused suture and reshape the skull. Then plates and screws hold the new head shape while the bone heals. The plates and screws are made of a special material that breaks down and dissolves completely in one or two years.
The best method is the one that works best for your baby. Talk with your child’s team in more detail about both options so you can decide together which is the right option for your baby and family. Our surgeons and social workers can give you both information and support to help you make a decision.
What is your experience with endoscopic strip craniectomy?
Our craniosynostosis program is one of the largest in the country. We see more than 70 new children with craniosynostosis each year.
Two of our plastic surgeons and two of our neurosurgeons work in teams to perform endoscopic strip craniectomies.
This method, using the helmet, is newer than the open method, and it’s not offered everywhere craniosynostosis is treated. As more babies have had the surgery followed by a helmet, we have closely studied the results. We began to offer this option at Seattle Children’s after seeing that it’s safe and effective and learning which babies are most likely to benefit from it.
The entire team at Children’s helps you and your family through the surgery, hospital stay and follow-up visits. Before surgery, you see a craniofacial pediatrician. This doctor checks your baby’s condition and talks with you about treatment options.
We connect you with other team members based on your baby’s and family’s needs. All families who are deciding on surgery for craniosynostosis meet with a social worker from the Craniofacial Center.
Your social worker can help with a range of topics, such as:
- Asking the surgeons questions, talking about concerns and thinking about which surgery to choose
- Planning so that treatment goes as smoothly as possible for your family
- Coping during treatment, including getting your child to wear their helmet
- Dealing with time off work to come to surgery and follow-up visits
- Getting resources to travel from home to the hospital
- Dealing with your insurance and any worries about costs
Seattle Children’s is one of the places that helped design the helmet used after the surgery. We have two craniofacial orthotists who work with patients who wear helmets. After surgery, both the plastic surgeon and neurosurgeon take part in your baby’s follow-up visits to make sure the helmet is working well.