Endoscopic Strip Craniectomy for Craniosynostosis

Overseen By Betty Tung, MS

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Baylor College of Medicine

Disqualifiers: Over 6 months old

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 1 day (surgery)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial compares two types of a less invasive surgery called endoscopic strip craniectomy, used to treat children under 6 months with sagittal craniosynostosis, a condition where the skull bones fuse too early. The researchers aim to evaluate each method's effectiveness in terms of head shape and recovery, and to determine if adding an extra step in the surgery (lateral osteotomies) makes a difference. The trial is open to babies under 6 months diagnosed with isolated, non-syndromic sagittal craniosynostosis at Texas Children's Hospital. As an unphased trial, it offers a unique opportunity to contribute to medical knowledge and potentially improve surgical outcomes for future patients.

Will I have to stop taking my current medications?

The trial information does not specify whether participants must stop taking their current medications.

What prior data suggests that endoscopic strip craniectomy is safe for children with craniosynostosis?

Research has shown that endoscopic strip craniectomy (ESC) is a safe and effective treatment for craniosynostosis, a condition where a baby's skull bones fuse too early. This treatment is well-researched and is considered a top choice for babies, especially compared to more invasive surgeries.

Surgeons can perform ESC with or without extra bone cuts, based on what they deem best. Studies have found no major differences in safety or outcomes between these methods, indicating that both are well-tolerated by patients.

After ESC surgery, babies typically wear a helmet to help shape their skulls during healing. This common practice helps achieve good results. Research supports the safety of this procedure, making it a dependable option for treating craniosynostosis in young children. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about endoscopic strip craniectomy for craniosynostosis because it offers a less invasive technique compared to traditional open surgery. This method, particularly when combined with lateral osteotomies, allows surgeons to make smaller incisions and requires less manipulation of the skull, potentially reducing recovery time and minimizing scarring. Additionally, pairing the procedure with post-operative helmet therapy helps guide the natural growth of the skull, aiming for optimal cosmetic and functional outcomes. This approach highlights a significant shift towards more patient-friendly interventions in treating craniosynostosis.

What evidence suggests that this trial's treatments could be effective for craniosynostosis?

Studies have shown that endoscopic strip craniectomy (ESC) with a helmet worn after surgery is a safe and effective treatment for isolated, non-syndromic sagittal craniosynostosis in young children. This procedure is considered the best option because it reduces the risk of complications during and after surgery compared to more invasive methods. In this trial, participants will undergo ESC either with or without extra bone cuts, known as lateral osteotomies. Research has shown no significant difference in skull expansion between these two methods. However, differences in appearance and recovery remain under investigation. Overall, ESC is a proven method for treating this condition. ^{1 2 3 5 6}

Who Is on the Research Team?

David F Bauer, MD, MPH

Principal Investigator

Baylor College of Medicine

Are You a Good Fit for This Trial?

This trial is for babies under 6 months old with a condition called isolated, non-syndromic sagittal craniosynostosis. They must be patients at Texas Children's Hospital and able to have the surgery before reaching 6 months of age.

Inclusion Criteria

My child has a skull condition and is under 6 months old.

Exclusion Criteria

I cannot have a specific skull surgery by 6 months old.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo endoscopic strip craniectomy with or without lateral osteotomies, followed by post-operative helmeting

1 day (surgery)

1 visit (in-person for surgery)

Post-operative Monitoring

Standard post-operative visits and measurements of cephalic index using the STARscanner©, along with chart reviews

30 days

Multiple visits (in-person)

Follow-up

Participants are monitored for cranial expansion and aesthetic outcomes at 1 year post-operatively

1 year

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Endoscopic strip craniectomy (with lateral osteotomies) with post-operative helmet therapy
• Endoscopic strip craniectomy (without lateral osteotomies) with post-operative helmet therapy
• Endoscopic strip craniectomy with post-operative helmet therapy

Trial Overview The study compares two surgical methods for treating sagittal craniosynostosis: endoscopic strip craniectomy (ESC) both with and without lateral osteotomies, followed by helmet therapy. It aims to see which method is better for skull shape and safety.

How Is the Trial Designed?

Group I: Endoscopic strip craniectomy without the use of lateral osteotomies Experimental Treatment 1 Intervention

Patients will NOT have lateral osteotomies incorporated into their surgical procedure following suturectomy of the fused sagittal suture.

Group II: Endoscopic strip craniectomy with the use of lateral osteotomies Active Control 1 Intervention

Patients will have lateral osteotomies incorporated into their surgical procedure following suturectomy of the fused sagittal suture.

Endoscopic strip craniectomy (with lateral osteotomies) with post-operative helmet therapy is already approved in European Union, United States, Canada for the following indications:

Approved in European Union as Endoscopic Strip Craniectomy for:

• Isolated, non-syndromic sagittal craniosynostosis in children under 6 months of age

Approved in United States as Endoscopic Strip Craniectomy for:

• Isolated, non-syndromic sagittal craniosynostosis in children under 6 months of age
• Syndromic craniosynostosis in selected cases

Approved in Canada as Endoscopic Strip Craniectomy for:

• Isolated, non-syndromic sagittal craniosynostosis in children under 6 months of age

Who Is Running the Clinical Trial?

Baylor College of Medicine

Lead Sponsor

Trials

1,044

Recruited

6,031,000+

Published Research Related to This Trial

A study of 100 infants with craniosynostosis showed that minimally invasive endoscopic strip craniectomies are safe, with no major complications and a low average blood loss of 26.2 mL during surgery.

The procedure, combined with helmet molding therapy, effectively normalizes craniofacial deformities, allowing most patients to be discharged the day after surgery, making it a valuable alternative to traditional surgical methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy. Jimenez, DF., Barone, CM., Cartwright, CC., et al.[2022]

A case study of a two-month-old baby who underwent surgery for sagittal synostosis revealed that inconsistent use of an orthotic helmet after surgery may lead to complications, including the development of pansynostosis, which required further surgical intervention.

The findings emphasize the need for proper parent education and regular follow-up appointments to monitor helmet therapy and prevent potential complications in craniofacial treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pancraniosynostosis following endoscopic-assisted strip craniectomy for sagittal suture craniosynostosis in the setting of poor compliance with follow-up: a case report. Sivakumar, W., Goodwin, I., Blagg, R., et al.[2018]

A retrospective study of 13 patients undergoing minimally-invasive nonendoscopic suturectomy for craniosynostosis showed that the procedure is safe, with only one mild intraoperative complication and no postoperative complications, while maintaining a short hospital stay of about 1.77 days.

Long-term follow-up indicated significant improvements in skull shape and symmetry, comparable to results from endoscopic techniques, suggesting that nonendoscopic suturectomy is an effective alternative for treating nonsyndromic craniosynostosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suturectomies Assisted by Cranial Orthosis Remodeling for the Treatment of Craniosynostosis Can Be Performed Without an Endoscope. Olshinka, A., Har-Shai, L., Novitski, I., et al.[2021]

Endoscopic strip craniectomy, while introduced as a safe and effective method for treating craniosynostosis, has shown cases where patients required additional surgery due to inadequate initial treatment, highlighting potential limitations of the procedure.

An informal survey of craniofacial specialists revealed discrepancies between published outcomes and real-world experiences regarding complications, indicating a need for more thorough research to clarify the effectiveness and safety of this technique.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Endoscopic Strip Craniectomy for Craniosynostosis: Do We Really Understand the Indications, Outcomes, and Risks? Kung, TA., Vercler, CJ., Muraszko, KM., et al.[2018]

Patients with sagittal craniosynostosis (SC) completed helmet therapy at a younger age (7.88 months) and for a shorter duration (4.17 months) compared to those with metopic craniosynostosis (MC), who required therapy until 10 months and for 6 months.

The type of craniosynostosis significantly affects the duration and number of helmets needed for postoperative therapy, with MC patients needing longer and more helmets than SC patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of Helmeting Therapy Duration After Endoscopic Strip Craniectomy for Metopic and Sagittal Craniosynostosis. Nguyen, HT., Washington, GN., Cepeda, A., et al.[2023]

Endoscopically assisted wide-vertex strip craniectomy is a safe and effective treatment for sagittal craniosynostosis, showing comparable outcomes to open calvarial vault reconstruction, with a significantly shorter operating time (88 minutes vs. 179 minutes) and reduced blood loss (29 ml vs. 218 ml).

Patients undergoing the endoscopic procedure had a shorter hospital stay (1.2 days vs. 3.9 days) and lower transfusion rates (6.4% for endoscopic vs. 100% for open surgery), indicating a lower morbidity associated with the endoscopic approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience. Shah, MN., Kane, AA., Petersen, JD., et al.[2022]

The single-incision endoscopic strip craniectomy for treating sagittal craniosynostosis in infants offers cosmetic benefits and lowers the risk of wound complications compared to the traditional two-incision method.

This technique enhances endoscopic visualization, which helps minimize blood loss during surgery, an important factor given the limited blood volume in young infants.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Single incision endoscopic strip craniectomy for sagittal craniosynostosis. Ahn, ES., Bhandarkar, AR.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4154971/

Endoscopic-Assisted Craniosynostosis Surgery - PMC Although not a cure-all, endoscopic-assisted craniosynostosis surgery is safe and effective. It adds another option in our treatment armamentarium for ...

2. thejns.org thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/32/3/article-p277.xml

Multicenter comparison of head shape outcomes for three ... The objective of this multicenter study was to provide an analysis of long-term results following three different endoscopic strip craniectomy ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT04721769?term=AREA%5BConditionSearch%5D(Saethre-chotzen%20syndrome%20OR%20%22acrocephalosyndactyly%20type%203%22%20OR%20%22%20ACS3%22%20OR%20%22%20Saethre%20Chotzen%20Syndrome%22%20OR%20%22%20Saethre-Chotzen%20syndrome%20with%20or%20without%20eyelid%20anomalies%22%20OR%20%22%20SCS%22%20OR%20%22%20type%20III%20Acrocephalosyndactyly%22)%20AND%20AREA%5BOverallStatus%5D(NOT_YET_RECRUITING%20OR%20RECRUITING)&rank=1

Endoscopic Strip Craniectomy for Treatment of Sagittal ... Endoscopic strip craniectomy (ESC) with post-operative helmeting is the gold-standard treatment for isolated, non-syndromic sagittal craniosynostosis in ...

4. journals.lww.com journals.lww.com/jcraniofacialsurgery/fulltext/2016/03000/endoscopic_strip_craniectomy_for_craniosynostosis_.5.aspx?generateEpub=Article%7Cjcraniofacialsurgery:2016:03000:00005%7C10.1097/scs.0000000000002364%7C

Endoscopic Strip Craniectomy for Craniosynostosis: Do We ... ... effective way to treat many forms of craniosynostosis. Despite the promise of endoscopic surgery for craniosynostosis, however, it is important to recognize ...

5. seattlechildrens.org seattlechildrens.org/clinics/craniofacial/services/endoscopic-strip-craniectomy/

Endoscopic Strip Craniectomy An endoscopic strip craniectomy is a surgery to remove a fused suture in babies with some types of craniosynostosis.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9648654/

Endoscopy in Craniosynostosis Surgery: Evolution and ... For endoscopic-assisted management of craniosynostosis, the suggested target patient age is less than 3 months. Although age of intervention may ...