Endoscope-assisted suturectomy for craniosynostosis in a resource-limited setting: A pilot case study in Peshawar

Introduction

Unicoronal craniosynostosis is a congenital condition where one of the coronal sutures in the skull fuses prematurely, leading to asymmetric head shape and facial deformities. This condition often results in a noticeable abnormality in head and facial features, which can impact both appearance and neurological development if not treated on time.

Case

We present a case of a 4-month-old female infant with left-sided unicoronal craniosynostosis who presented to Northwest General Hospital and Research Centre with abnormal head shape. After clinical examination showed unicoronal craniosynostosis which was investigated with a 3D CT scan that confirmed the diagnosis. She underwent endoscope-assisted suturectomy, a less invasive technique compared to traditional open surgery. A 3 cm incision was made, followed by resection of a 1.5 cm wide strip of bone from Anterior fontanelle down to the squamosal suture. Post-operatively, she spent 24 hours in the pediatric ICU as part of protocol, received IV fluids, pain management, and antibiotics. She was discharged the next day. Two weeks following the surgery Helmet therapy was started which was continued for six months resulting in significant improvement in her head shape and facial asymmetry.

Conclusion

Unlike the traditional approach, which requires longer scalp incisions and results in longer operative time, longer hospital stays, higher blood loss, and increased risks of complication, the endoscopic method involves entirely the opposite of those, a smaller incision, lesser operative time, hospital stay, bleeding, and low risks of complication. This minimally invasive approach allows for quicker recovery, shorter hospital stays, and improved cosmetic outcomes and to the best of our knowledge endoscope assisted suturectomy for craniosynostosis has not been done in this region before.