Purpose Statement: Sagittal synostosis is the most common of the craniosynostoses. Open cranial vault reconstruction has traditionally been the treatment of choice at most centers. The purpose of our study was to evaluate endoscopic sagittal split craniectomy as an alternative treatment of sagittal synostosis. The proposed benefits of this approach include earlier age at operation, lower intraoperative and postoperative blood loss with fewer required transfusions, shorter operative time, shorter hospitalization time, and fewer intraoperative and postoperative complications.

Methods/Materials: Patients with a diagnosis of sagittal synostosis at Primary Children's Medical Center, being treated by the senior author (F.S.), were offered the option of the endoscopic approach during discussions with the parents. To date, 11 patients have been included in the study since its inception in 2006. Quantitative assessments were performed, including age at operation, pre- and postoperative cephalic index, pre- and postoperative hematocrit, length of operation, length of hospitalization, intraoperative fluid administration, estimated blood loss, craniectomy size, intraoperative complications, and postoperative complications and course.

Results: For the 11 patients who have been included in the study thus far, the mean hospital stay was 2 days and the mean operative time was 86.7 minutes. The mean estimated blood loss was 65 ml with a mean of 39.1 ml of packed red blood cells transfused intraoperatively. One patient sustained a dural tear. There were no sagittal sinus injuries, air embolisms, or parenchymal injuries. None of the procedures required conversion to an open approach. Postoperatively, none of the patients experienced seizures or developed hematomas, infections, pyrexia, coagulopathies (defined as INR >1.4), or death. No patients received postoperative blood transfusions. One patient developed a CSF leak. None of the patients required reoperation.

Conclusions: Endoscopic sagittal split craniectomy is an effective approach to treating sagittal synostosis. The benefits over open cranial vault reconstruction include a shorter operative time, shorter hospitalization, lower blood loss, fewer required blood transfusions, and fewer intra- and postoperative complications.