Endoscopic Treatment of Craniosynostosis Our Approach May 8, 1997

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Endoscopic Treatment of Craniosynostosis Our
ApproachMay 8, 1997 March 30, 2005

• Constance M. Barone, M.D.
• David F. Jimenez, M.D.
• University of Texas Health Science Center
• San Antonio, Texas

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All Sutures

• Sagittal 108 M 39 F 147
• Coronal 30 M 37 F 67
• Metopic 41M 18 F 59
• Lambdoid 7M 3F 10
• Total number of patients 283
• Total number of sutures 300

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Average Age of Pts. (Months)

• Sagittal 3.6 months
• Coronal 3.8 months
• Metopic 4.2 months
• Lambdoid 5.2 months
• Average of all 4.2 months

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Average Weight (kg)

• Avg Sagittal 6.30
• Avg Coronal 6.38
• Avg Metopic 6.48
• Avg Lambdoid 7.39
• Avg all 6.63

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Estimated Blood Loss (cc)

• Sagittal 28.2 (avg)
• Coronal 19.5 (avg)
• Metopic 33.4 (avg)
• Lambdoid 23.0 (avg)
• Overall Average 26.0cc

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Craniectomy Size (cm)

• Width x
  Length
• Average Sagittal 5.5 cm x 10.4
• Average Coronal 0.68 x 10.6
• Average Metopic 0.71 x 9.8
• Average Lambdoid 1.6 x 7.5
• Average of all surgeries 2.1 x 9.6

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Length of Stay (days)

• Avg Sagittal 1.07
• Avg Coronal 1.03
• Avg Metopic 1.00
• Avg Lambdoid 1.00
• Avg all 1.02

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Operative Time (minutes)

• Sagittal Metopic Coronal
• 57 (mean) 57 56
• 25-150 30-90 25-60

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Blood Transfusions

• Sagittal Metopic
  Coronal
• Intraop 2 (1.4) 0
  0
• Postop 12 (8.5) 4 (3.4) 0
• Total 14 (10) 4 (3.4) 0

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Results

• 
  Sagittal Metopic Coronal
• Incomplete ossification 0 2
  3
• Abnl ossification 4 0
  0
• Dural Tear 1
  0 0
• Coagulopathies 1 0
  0
• CSF leak 0
  2 0
• Venous air embolism 0 2 (II)
  0
• VP shunt 3
  0 0

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Results

• Hematomas, Infections, Seizures, Convert to Open,
  Reoperation, Intrparenchymal Injury, Neurologic
  Injuries, Ocular Injuries, Injury to Sagittal
  Sinus 0

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Methods Materials
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SAGITTAL SUTURE
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Pre Op
Immediate Post-Op
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Sagittal Results

• Cephalic Index
• Excellent gt 75
• Good 70 -75
• Poor lt 70
• Mean Preop CI 67.4 (61 90)

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Sagittal Results

• Excellent 87
• Good 8.7
• Poor 4.3

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ENDOSCOPIC SURGERY RESULTS
AFTER
BEFORE
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BEFORE
AFTER
1 YEAR
3 YEARS
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BEFORE
AFTER
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METOPIC
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4 MONTHS POST
PRE - OP
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PRE - OP
1 YEAR POST
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1 YEAR POST
PRE - OP
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preop 4
years
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CORONAL
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CORONAL SUTURE
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CORONAL SUTURE
FRONTAL DURA
TEMPORAL DURA
SPHENOIDS LESSER WING
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2 month female
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CLINICAL CASES

• Patient TM
• Age 2 months
• Sutural Involvement
• Left Coronal
• Sagittal
• Left Lambdoid

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Pre op
3 years
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2 yrs
Pre op
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Pre op
2 yrs
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CLINICAL CASES

• Patient NM
• Age 2 months
• Sutural Involvement
• Right Coronal
• Metopic

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MULTIPLE SUTURES
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Pre op
1 yr
3 yrs