# Craniosynostosis — GCMD Library living collection

Experts: Dr. Mark Proctor

Updated: n/a · 1 episodes · 53 cited statements

## Episodes
### Surgical Management
- [Endoscopic Treatment of Craniosynostosis: Pediatric Endoscopic Neurosurgery 2018](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381) — video · 34:23 · [machine version](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=0) Introduction and craniosynostosis anatomy (Ep 1)
- [3:49](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=229) Specific synostosis patterns and deformities (Ep 1)
- [6:05](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=365) Evolution of surgical approach and endoscopic rationale (Ep 1)
- [11:11](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=671) Endoscopic technique for sagittal synostosis (Ep 1)
- [16:44](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1004) Helmet therapy and outcomes data (Ep 1)
- [20:07](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1207) Summary and recommendations (Ep 1)
- [20:57](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1257) Q&A: Scope heat, age limits, and cranial index thresholds (Ep 1)
- [24:08](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1448) Q&A: Why suturectomy works now versus 1960s (Ep 1)
- [26:57](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1617) Q&A: Perioperative management and imaging utility (Ep 1)
- [31:26](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1886) Q&A: Helmet duration by suture type and bone removal amount (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Human skull is made up of 5 major bones separated by growth plates called sutures." — Mark Proctor (clinical) [Ep 1 · 1:25](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=85)
- "Humans have very rapid brain growth in the first year of life, slowing considerably over the second year; past 2 years of age sutures play a very small role in skull or brain growth." — Mark Proctor (clinical) [Ep 1 · 1:56](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=116)
- "Virchow's law defines that skull growth is normally perpendicular to the sutures; if bone is closed, growth occurs parallel to sutures due to compensatory overgrowth in other areas." — Mark Proctor (clinical) [Ep 1 · 2:27](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=147)
- "Synostosis affects about 1 in every 2000 live births, with sagittal being by far the most common in about half of children." — Mark Proctor (epidemiological) [Ep 1 · 2:54](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=174)
- "In sagittal synostosis, the back of the head is the narrowest part (whereas normally it is the widest), with wide and bossed frontal region." — Mark Proctor (clinical) [Ep 1 · 3:56](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=236)
- "In unilateral coronal synostosis, there is orbital dystopia where the orbit on the affected side is higher and shallower, and the nose deviates toward the affected side." — Mark Proctor (clinical) [Ep 1 · 4:27](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=267)
- "Lambdoid synostosis is very rare, representing about 1 to 2% of all synostosis cases; Boston Children's sees about 100 new synostosis patients per year and averages 1 lambdoid case annually." — Mark Proctor (epidemiological) [Ep 1 · 5:20](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=320)
- "In lambdoid synostosis, the mastoid should be low (extended) on the affected side, which helps distinguish it from deformational changes." — Mark Proctor (clinical) [Ep 1 · 5:37](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=337)
- "Strip craniectomy results were poor historically, with about one-third of patients having bones fuse together before significant correction, leading to adoption of larger cranial vault reconstructions." — Mark Proctor (clinical) [Ep 1 · 6:14](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=374)
- "David Jimenez and Constance Barone in the mid-1990s pioneered endoscopic synostosis surgery with smaller incisions, less blood loss, and adjuvant helmet therapy." — Mark Proctor (clinical) [Ep 1 · 6:46](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=406)
- "Open surgery is a mechanical operation where bones are repositioned and fixed, but those bones don't grow normally over time; results at end of surgery aren't completely predictive of outcomes 5 or 10 years later." — Mark Proctor (clinical) [Ep 1 · 7:51](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=471)
- "Endoscopic surgery is a release procedure that relies on brain growth to move bones out over time or requires adjuncts like springs, distractors, or helmets to direct growth." — Mark Proctor (clinical) [Ep 1 · 8:25](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=505)
- "Conceptually, endoscopic surgery turns synostosis into a deformational problem by opening bones to make them malleable, then reshaping with a helmet." — Mark Proctor (clinical) [Ep 1 · 8:53](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=533)
- "Laparoscopic cholecystectomy was first reported in 1987 by a team in France and met significant early skepticism before becoming standard of care." — Mark Proctor (clinical) [Ep 1 · 9:22](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=562)
- "Only surgeons involved with open cholecystectomy and management of its potential complications should perform laparoscopic cholecystectomy (quote from historical article applied to craniosynostosis context)." — Mark Proctor (opinion) [Ep 1 · 10:47](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=647)
- "CDC parameters of care for synostosis (2010–2012) consider endoscopic surgery a viable treatment option but stress the need for a very experienced team." — Mark Proctor (guideline) [Ep 1 · 11:11](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=671)
- "For sagittal synostosis endoscopic surgery, a 0-degree endoscope is used; Proctor avoids using high-quality neurosurgical scopes to prevent damage in this relatively blunt procedure." — Mark Proctor (clinical) [Ep 1 · 12:46](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=766)
- "Meticulous technique is necessary to keep blood transfusion rates down in endoscopic craniosynostosis surgery." — Mark Proctor (clinical) [Ep 1 · 13:14](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=794)
- "For sagittal synostosis, two incisions are made (anterior and posterior), burr holes created and expanded with Kerrison rongeurs to about a 2 cm gap." — Mark Proctor (clinical) [Ep 1 · 13:22](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=802)
- "Recent studies from Hopkins, DC, and Saint Louis show that narrow (2 cm) bone strips are just as effective as wide (6 cm) strips; most centers now use narrow strips with no barrel staves." — Mark Proctor (clinical) [Ep 1 · 15:44](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=944)
- "Helmets allow real-time adjustment (e.g., if top of head is getting flat, can adjust for more rounding), whereas springs or distractors cannot be adjusted." — Mark Proctor (clinical) [Ep 1 · 16:51](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1011)
- "Endoscopic treatment leads to sustained changes in cranial index over time, with results very similar to open operation from a cranial index perspective (compared by multiple groups)." — Mark Proctor (clinical) [Ep 1 · 17:14](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1034)
- "In unilateral coronal synostosis treated endoscopically, neo-suture formation can occur, making it appear as if the patient never had a fused suture." — Mark Proctor (clinical) [Ep 1 · 17:51](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1071)
- "3D photogrammetry studies show facial asymmetry improved significantly more in the endoscopic group than in the frontal orbital advancement group, likely due to early release." — Mark Proctor (clinical) [Ep 1 · 18:20](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1100)
- "Astigmatism improved much better with endoscopic surgery compared to open surgery." — Mark Proctor (clinical) [Ep 1 · 18:39](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1119)
- "First 100 consecutive endoscopic cases (all synostosis types): mean surgical time 48 minutes, estimated blood loss 23 mL, 8 transfusions, median hospital stay 1 day." — Mark Proctor (clinical) [Ep 1 · 18:55](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1135)
- "Weight under 5 kg was a risk factor for transfusion; now waiting until over 5 kg for all patients, transfusion rates down to about 3%." — Mark Proctor (clinical) [Ep 1 · 19:08](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1148)
- "Cost of endoscopic treatment is 40% of open operation; three studies (Boston, Saint Louis, Midwest US) show consistent results." — Mark Proctor (clinical) [Ep 1 · 19:25](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1165)
- "Boston cost study included all hospital costs, home costs, and gas mileage for families traveling to orthotist appointments." — Mark Proctor (clinical) [Ep 1 · 19:43](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1183)
- "In experienced centers, both open and endoscopic craniosynostosis surgery should be very safe procedures." — Mark Proctor (opinion) [Ep 1 · 20:07](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1207)
- "Centers should have access to both minimally invasive and open techniques, and provide comprehensive care including surgery, neuropsych testing, and orthotist access." — Mark Proctor (opinion) [Ep 1 · 20:17](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1217)
- "Endoscope exposure to dura during dissection is very brief (20–30 seconds on average for sagittal synostosis); light source typically used at 70–75% (not 100%)." — Mark Proctor (clinical) [Ep 1 · 21:26](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1286)
- "Endoscope appears to generate less heat than the drill; no injuries from scope heat have been observed." — Mark Proctor (clinical) [Ep 1 · 21:53](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1313)
- "Ideal surgical age for endoscopic craniosynostosis is about 10 to 12 weeks (3 months), when brain growth is most rapid." — Mark Proctor (clinical) [Ep 1 · 22:37](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1357)
- "Oldest patient treated endoscopically was 7 months of age (mild sagittal synostosis); result was reasonable but correction is less robust at older ages due to reduced brain growth." — Mark Proctor (clinical) [Ep 1 · 23:13](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1393)
- "Would not offer endoscopic surgery past 6 months for severe deformity (e.g., cranial index 0.62); may extend to 5–6 months for milder cases (cranial index 0.7 or 0.72)." — Mark Proctor (opinion) [Ep 1 · 23:34](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1414)
- "Historical strip craniectomy had 20–30% rate of suture closing back before significant correction; current approach differs by using adjuvant therapy (helmets, springs, distractors) to direct growth." — Mark Proctor (clinical) [Ep 1 · 24:31](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1471)
- "In helmeted sagittal synostosis, the goal is 2:1 growth ratio (width to length) during helmet course; starting cranial index 0.75 reaches about 0.8 after 6 months." — Mark Proctor (clinical) [Ep 1 · 25:57](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1557)
- "Head circumference must be tracked closely during helmet therapy; do not want to see fall-off on growth curve; ideally should see a jump up with the operation." — Mark Proctor (clinical) [Ep 1 · 26:35](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1595)
- "Early endoscopic cases used two large IVs and an arterial line (treated like open cases); current standard is two IVs only, no A-line, no Foley catheter." — Mark Proctor (clinical) [Ep 1 · 27:36](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1656)
- "Some endoscopic craniosynostosis patients could truly go home the same day, though Proctor has never been bold enough to do so; most stay overnight (often as 23-hour observation rather than formal admission)." — Mark Proctor (clinical) [Ep 1 · 28:16](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1696)
- "Average sagittal synostosis case is so classic that most surgeons can diagnose without imaging; imaging obtained if any question exists to avoid operating on open suture or missing a fused suture." — Mark Proctor (clinical) [Ep 1 · 29:35](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1775)
- "Well under 10–20% of craniosynostosis patients require imaging to make the diagnosis." — Mark Proctor (clinical) [Ep 1 · 30:11](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1811)
- "For sagittal synostosis, plain X-ray may suffice instead of CT scan; unilateral coronal can almost always be diagnosed on exam (nasal deviation, eye height, ear position)." — Mark Proctor (clinical) [Ep 1 · 30:21](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1821)
- "Would never consider operating on lambdoid synostosis without a CT scan; it is a very difficult diagnosis to make clinically." — Mark Proctor (opinion) [Ep 1 · 30:40](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1840)
- "Ultrasound is increasingly used to show open versus closed sutures without radiation exposure; literature on this is growing." — Mark Proctor (clinical) [Ep 1 · 30:53](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1853)
- "MRI black-bone studies are a potential viable technique to show suture status and brain detail better than other modalities, though not yet adopted at Boston Children's." — Mark Proctor (clinical) [Ep 1 · 31:05](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1865)
- "For metopic synostosis, helmet can be stopped as soon as desired shape is achieved (as short as 3 months); there is essentially no regression." — Mark Proctor (clinical) [Ep 1 · 32:03](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1923)
- "For sagittal synostosis, there is definite regression; patients lose on average 0.02 cranial index between 1 and 2 years of age." — Mark Proctor (clinical) [Ep 1 · 32:27](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1947)
- "Average helmet duration for sagittal synostosis is 7 months from surgery; Proctor pushes closer to 1 year unless cranial index exceeds 0.82." — Mark Proctor (clinical) [Ep 1 · 32:57](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=1977)
- "For unilateral coronal, there is no regression, but almost none are perfect at 1 year, so helmet is almost always continued to 1 year." — Mark Proctor (clinical) [Ep 1 · 33:23](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=2003)
- "Jimenez now standardly helmets sagittal synostosis patients for 18 months; Proctor thinks loss between 1 and 2 years is so small that helmet value after 1 year is very small." — Mark Proctor (opinion) [Ep 1 · 33:32](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=2012)
- "For coronal synostosis, bone removal is also about 1 to 2 centimeters, similar to sagittal." — Mark Proctor (clinical) [Ep 1 · 33:57](https://qa.library.globalcastmd.com/watch/endoscopic-treatment-of-craniosynostosis-pediatric-endoscopic-neurosurgery-2018-381?t=2037)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Aug 31: 1 doctors auto-found from episode dossiers
- Aug 30: 1 doctors auto-found from episode dossiers
- Aug 30: 1 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 3 doctors auto-found from episode dossiers
- Aug 29: 3 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 4 items, 4 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 4 items, 4 dossiers, summaries for 4 audience(s)

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