Introduction: Endoscopic third ventriculostomy has been suggested as the method of choice for treatment of obstructive hydrocephalus.
The overall complication rate is 8.5% ranging from 0% to 31.2% in different series. Having a bone flap has been suggested to decrease the wound complications. An alternative method of minicraniotomy for children less than one year old is introduced. Minicraniotomy could be easily done, providing good dural closure,and restoring the bone integrity.
Methods: Case control study was done; 15 infants in case and 30 in control group.Minicraniotomy was performed in case group and burr hole was performed in control.Posterior border of frontal bone at coronal suture was dissected and made free from Dura. Two parallel linear osteotomy are performed at frontal bone in 15mm diameter which make small bone flap that is elevated to anterior with greensick fracture. Bone flap remains attached to the bone around. Dura is opened with cruciate incision and then corticotomy is performed. After performing the procedure, dural closure is done with nonabsorbable sutures.
Results: Mean age of patients at case and control group was 5.2m and 5.06m respectively. Hydrocephalus (73%) was the most common etiology followed by arachnoid cyst(20%). Among 15 patients in micocraniotomy group 2 (13%) developed one kind of complications, compared to 8 out of 30 in control group. Minicraniotomy group had only 2 CSF collection without any infection or dehiscence or leakage.
Conclusions: Two groups were similar according to age, sex and cause of their disease. Mean age of patients at case and control group was 5.2m and 5.06m respectively. Hydrocephalus (73%) was the most common etiology followed by arachnoid cyst(20%). Among 15 patients in micocraniotomy group 2 (13%) developed one kind of complications, compared to 8 out of 30 in control group. Minicraniotomy group had only 2 CSF collection without any infection or dehiscence or leakage.
Patient Care: Minicraniotomy is possible in infants with exactly the same time that takes for burr hole to find access to intracranial contents. It is associated with less complications.
The technique was associated with less complications and improved the postoperative period.
Learning Objectives: Minicraniotomy is performed at the same operation time that burr hole is performed due to more space comparing to nurr hole, dural closire is possible in this technique. The complication is lower in minicraniotomy compare to burr hole so we can suggest and use this method as an alternative method in infants with thin skull