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A Single-Incision Endoscopic Approach for Craniosynostosis

Pediatric surgeon Edward Ahn takes a minimally invasive procedure a step further

By Gary Logan

Date: 12/14/2016

A Single-Incision Endoscopic Approach for Craniosynostosis

Pediatric neurosurgeon Edward Ahn measures Jonah Cantu’s head at his one-year follow-up appointment. “He’s had an excellent outcome,” Ahn tells his young patient’s mother, Amelia Cantu.

When Jonah Cantu was born, his mother immediately noticed his head was an unusual shape.

“I was in shock and knew something was wrong,” says Amelia Cantu of Welcome, Maryland. “His head was long, like a banana.”

Doctors at an outside hospital diagnosed Jonah with craniosynostosis and referred him to the Johns Hopkins Children’s Center and pediatric neurosurgeon Edward Ahn, nationally known for his innovative approaches in treating the condition. In the early 2000s, Ahn was among the first neurosurgeons to use an endoscopic approach for sagittal craniosynostosis surgery, avoiding the need for an open operation and an ear-to-ear incision. Then, he made refinements to this minimally invasive procedure, including the use of an ultrasonic bone cutter to minimize blood loss. Reducing blood loss—the riskiest part of the operation—is especially important because even a small amount of lost blood is proportionally large for tiny patients like Jonah.

Ahn confirmed Jonah’s diagnosis of saggital craniosynostosis and offered Amelia the two surgical options—the open procedure in nine to 12 months when Jonah would be strong enough to withstand the surgery, or the endoscopic procedure within three months of birth. While the traditional operation usually necessitates blood transfusions for all patients, Ahn explained, with the newer procedure, only one-fifth will require a transfusion. Additionally, patients who have the newer operation typically spend only one night in the hospital, compared with up to a week for the traditional procedure.

That was not all. Ahn informed the family that he had developed a novel, single-incision technique for the endoscopic approach. Traditionally, endoscope-assisted surgery for saggital craniosynostosis has involved two incisions, one at either end of the saggital suture. Ahn made it possible to perform the surgery through a single 3-centimeter incision. Not only would Jonah be at less risk of complications, like bleeding, he would have the cosmetic advantage of only one tiny scar.

“The biggest compliment to me,” says Ahn, “is when parents say their friends are amazed after they describe what their child went through as a baby, because they never would have known.”

Amelia agrees. After Jonah’s single-incision endoscopic surgery, he underwent helmet therapy for a year to help maintain the normal shape of his skull. At a mid-December follow-up appointment with Ahn, Amelia couldn’t have been more pleased.

“I look at baby pictures before and after surgery, and his head has totally changed,” she says. “Now he looks like a normal kid.”

Ahn concludes: “We’ve reported our first series of patients with this technique and found fewer complications and less blood loss overall than with the two-incisions. The head shapes are correcting very nicely.”