Sagittal Suture Synostosis: Endoscopic Approach, Key Points for the Neurosurgeons

Since its introduction by Jimenez and Barone in 1998, the endoscopic minimally invasive approach to sagittal suture synostosis has gained wide acceptance as a safe and effective technique. Compared with open cranial vault remodeling, the endoscopic strip craniectomy approach minimizes operative time, blood loss, transfusion rates, cost, and the length of hospital stays while resulting in excellent and durable surgical results when done in patients under 6 months of age. The strip craniectomy entails a craniectomy encompassing the entire length of the fused sagittal suture with or without wedge osteotomies, followed by the postoperative use of a custom-made cranial molding helmet. This approach can be broken down into two subtypes, a wide (4- to 6-cm) strip craniectomy with parietal wedge osteotomies as described by Jimenez and Barone or a narrow (2-cm) strip craniectomy without additional osteotomies.