• 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, 0^o, 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 0^oscope with footplate, but some colleagues prefer 30^oscope
• 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