Endoscopy-Assisted Craniosynostosis Surgery without Postoperative Helmet Molding Therapy

OBJECTIVE

Endoscopy-assisted craniosynostosis surgery (EACS) yields excellent surgical outcomes by minimizing blood loss, operative time, and hospital stays. Postoperative helmet therapy (PHT), commonly employed for head shape correction, involves frequent adjustments, potential complications, and high costs. Given the rising cost of helmet therapy, reduced insurance coverage, and limited availability in low- and middle-income countries, understanding success rates without helmet use is crucial. The present study analyses the anthropometric results of the first EACS series without PHT.

METHODS

A retrospective analysis of a single-center series involving 90 consecutive patients who underwent EACS without PHT from 2012 to 2022 was conducted, with a follow-up exceeding 3 years. The study exclusively included patients with nonsyndromic isolated sagittal synostosis, with 33 meeting the criteria. Craniometric measurements were obtained from preoperative, 1-year postoperative, and the latest computed tomography scans. For isolated sagittal synostosis cases, the cephalic index (CI) was calculated (CI >75 for excellent results, CI 70-75 for good results, and <70 for poor results). Collected data encompassed patient sex, age, and follow-up time.

RESULTS

The mean age was 84.8 ± 45.3 days (2.79 ± 1.49 months) within a range of 3-172 days. The preoperative mean CI was 68 ± 42, increasing to 76 ± 6 1 year postoperatively (mean difference +8 ± 6.3; P = 0.0001). Seventy-one percent of patients achieved excellent results, 23% good (CI = 70-75), and 6% poor. Reintervention was unnecessary.

CONCLUSIONS

EACS without PHT demonstrates favorable anthropometric results, cost reduction, and simplified postoperative management.

[Distal ventriculoperitoneal shunt catheter migration into the pulmonary artery: a rare complication]

Ventriculoperitoneal shunt placement is a common treatment for hydrocephalus, although not devoid of complications. We report a case of a 60-year-old male who underwent ventriculoperitoneal shunt implantation for the treatment of post-traumatic hydrocephalus. Thirteen months post- surgery, after an initial clinical improvement, the patient manifested gait and cognitive disorders. Chest X-rays and computed tomography revealed that the distal shunt catheter had migrated into the pulmonary artery. The catheter was removed by reopening the previous retroauricular incision followed by manual traction, without incidents. A new peritoneal catheter was implanted with immediate clinical improvement and no further complications two years after the second surgery. We communicate a rare complication of a standard neurosurgical procedure that can be detected by different healthcare professionals, and review its various forms of presentation and multidisciplinary management strategies from 19 similar clinical cases found in the literature.