Introduction: Minimally invasive synostectomy with post-operative helmet orthosis is increasingly used by neurosurgical providers in the management of sagittal craniosynostosis diagnosed in infancy. Since its introduction in the 1990s, the technique has evolved with many practitioners utilizing a limited osteotomy overlying the sagittal suture. Despite the reduction in need to access the lateral skull surface, modified prone/sphinx positioning remains popular with many neurosurgeons.
Prone positioning in craniofacial surgery is associated with both real and theoretical risks. Intraoperative extubation in the modified prone position presents the potential for catastrophic anoxic injury. Cervical hyperextension presents the potential for neurologic injury in the setting of congenital craniocervical spinal abnormalties to include segmentation anomalies and Chiari malformation. Alternative patient positioning with comparable access to the midline may enhance patient safety in this surgical population.
Methods: The authors utilized supine positioning with the head turned laterally on a horseshoe headholder on two consecutive patients undergoing minimally invasive sagittal synostectomy.
Results: Surgical time, estimated blood loss, post-operative hematocrit, transfusion volume, length of stay were reviewed for these cases, and found to be comparable to two cases within our program performed in the modified prone position. Synostectomy orientation and width were comparable.
Conclusions: In this small series, minimally invasive synostectomy for sagittal craniosynostosis was performed with conventional supine positioning, achieving comparable surgical outcomes to modified prone positioning. Supine positioning offers potential advantages to include reduced anesthetic risk and reduction in the need for pre-operative imaging in this patient population.
Patient Care: While relatively safe, the minimally invasive sagittal synostectomy still often relies on the sphinx position, which is known to have a higher risk of unplanned extubation. This work offers an alternative but effective method for surgical resection of the sagittal suture without use of the sphinx position.
Learning Objectives: By the conclusion of this session, particpants should be able to:
1) Describe the anesthetic concerns of the sphinx position.
2) Replicate the technique for lateral minimally invasive sagittal synostectomy.