Endoscopic Assisted Craniosystosis Surgery (EACS)

1024 1024 Hans Delye

Endoscopic Assisted Craniosynostosis Surgery (EACS)

Diagnosis: Scaphocephaly
  • 5-month old girl, clear scaphocephaly with frontal bossing, only limited occipital pointing
  • Funduscopy shows no sign of papiledema
  • CT scan:partially closed sagittal suture
EQUIPMENT USED
  • Storz Endoscope: Hopkins-II, 0o, 4 mm diameter scope (STZ7230AA)
  • ‘optical dissector’ , Storz endoscope shaft (50200ES)
  • The smallest bipolar forceps you can find for working in a very limited space
SURGICAL TIPS
  • Position patient in sphynx-positioning with vertex as horizontal as possible to allow easy access with endoscope
  • Make sure you carefully detach dura with sagittal sinus with small spatula through small burr hole before craniectomy – most of the time, this is very easy in parts with a closed suture, but can be challenging in some areas where the suture is still partially open
  • I prefer 0oscope with footplate, but some colleagues prefer 30oscope
  • Use floseal to reduce bloodloss from bony edges, but make sure to rinse most of it out again. If not there can be severe swelling postoperatively
  • When coagulating bridging veins, use the smallest bipolar available and use it upside-down to allow clear visualization with enough space for suction device and bipolar cauterization
Pre op
CONTRIBUTOR

Hans Delye

Pediatric Neurosurgeon, Radbound Medical Centre, Nijmegen, The Netherlands

All cases by: Hans Delye