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Endoscopic Treatment of Craniosynostosis Our Approach May 8, 1997 – March 30, 2005

Endoscopic Treatment of Craniosynostosis Our Approach May 8, 1997 – March 30, 2005. Constance M. Barone, M.D. David F. Jimenez, M.D. University of Texas Health Science Center San Antonio, Texas. All Sutures. Sagittal 108 M + 39 F = 147 Coronal 30 M + 37 F = 67

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Endoscopic Treatment of Craniosynostosis Our Approach May 8, 1997 – March 30, 2005

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  1. 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

  2. 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

  3. 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

  4. Average Weight (kg) • Avg Sagittal 6.30 • Avg Coronal 6.38 • Avg Metopic 6.48 • Avg Lambdoid 7.39 • Avg all 6.63

  5. Estimated Blood Loss (cc) • Sagittal 28.2 (avg) • Coronal 19.5 (avg) • Metopic 33.4 (avg) • Lambdoid 23.0 (avg) • Overall Average 26.0cc

  6. 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

  7. Length of Stay (days) • Avg Sagittal 1.07 • Avg Coronal 1.03 • Avg Metopic 1.00 • Avg Lambdoid 1.00 • Avg all 1.02

  8. Operative Time (minutes) • Sagittal Metopic Coronal • 57 (mean) 57 56 • 25-150 30-90 25-60

  9. 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

  10. 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

  11. Results Hematomas, Infections, Seizures, Convert to Open, Reoperation, Intrparenchymal Injury, Neurologic Injuries, Ocular Injuries, Injury to Sagittal Sinus = 0

  12. Methods & Materials

  13. SAGITTAL SUTURE

  14. Pre Op Immediate Post-Op

  15. Sagittal Results Cephalic Index • Excellent: > 75 • Good 70 -75 • Poor < 70 • Mean Preop CI: 67.4 (61 – 90)

  16. Sagittal Results • Excellent 87% • Good 8.7% • Poor 4.3%

  17. ENDOSCOPIC SURGERY RESULTS AFTER BEFORE

  18. BEFORE AFTER 1 YEAR 3 YEARS

  19. BEFORE AFTER

  20. METOPIC

  21. PRE - OP 4 MONTHS POST

  22. PRE - OP 1 YEAR POST

  23. 1 YEAR POST PRE - OP

  24. preop 4 years

  25. CORONAL

  26. CORONAL SUTURE

  27. CORONAL SUTURE FRONTAL DURA TEMPORAL DURA SPHENOID’S LESSER WING

  28. 2 month female

  29. CLINICAL CASES • Patient: TM • Age: 2 months • Sutural Involvement: • Left Coronal • Sagittal • Left Lambdoid

  30. Pre op 3 years

  31. 2 yrs Pre op

  32. 2 yrs Pre op

  33. CLINICAL CASES • Patient: NM • Age: 2 months • Sutural Involvement: • Right Coronal • Metopic

  34. MULTIPLE SUTURES

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