Endoscopic Strip Craniectomy

Endoscopic strip craniectomy is a minimally invasive procedure to treat craniosynostosis, a condition where the sutures in the skull fuse too early during an infant’s development. Endoscopic strip craniectomy, also called endoscopic release surgery, works to release the fused sutures, helping restore the shape of your baby’s head and face, and giving their brain enough room to grow safely.

The Craniofacial Program team at Boston Children’s Hospital includes experts in endoscopic strip craniectomy and other minimally invasive approaches to treating craniosynostosis in infants and children.

An endoscopic strip craniectomy is most often performed on babies between four to six months who have one or more fused sutures or craniosynostosis associated with a genetic condition such as:

• Apert syndrome
• Crouzon syndrome
• Pfeiffer syndrome
• Saethre-Chotzen syndrome

Before endoscopic release surgery, a member of our craniofacial team (a neurosurgeon and possibly a plastic surgeon) will examine your baby. They may order X-rays or CT scans to find out more about your child’s condition than they can see in a physical exam.

Day of endoscopic release surgery

You and your child should arrive about two hours before their scheduled surgery time.

The endoscopic release surgery takes about two hours of total time in the operating room, during which the neurosurgeon will:

• Make one or two small incisions on your baby’s scalp, then small holes in the skull to start separating the bone.
• Use a thin, flexible tube called an endoscope to separate the layers of the scalp and the coverings of the brain (called dura) from the bone and remove the fused suture.
• Close the incisions with stitches. Stitches usually dissolve and fall out in about two to three weeks.

Most children who undergo endoscopic strip release surgery recover quickly and are discharged after one night in the hospital.

What is helmet therapy?

After surgery, an orthotist at Boston Children’s or a facility closer to your home will fit your baby with a custom-made helmet that they’ll wear for six to nine months to reshape their skull and allow for normal brain growth. At first, your baby will wear the helmet 23 hours a day, but the hours per day often decrease over time.

Your child will be followed by members of the Craniofacial Program team for up to five or six years following endoscopic release surgery, with visits every three months during the first year and then annually to assess how well the skull is reshaping and how well the brain is developing. As part of our extensive follow-up care, we may recommend consultations with other specialties, such as ophthalmology, genetics, neuropsychology, and others.

Most children who undergo endoscopic strip craniectomy won’t have restrictions after surgery and recovery, and they won’t need further surgery. However, if your child has a known genetic syndrome contributing to their craniosynostosis, it’s possible that the skull bones can fuse back together, so there’s an increased chance of additional surgeries in the first two to three years of life.