Addressing unilateral lambdoid craniosynostosis using endoscopic suturectomy and barrel-stave osteotomies: surgical technique and literature review.
Sandi Lam, Kiichiro Yaguchi, William M Tian et al.
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Case in brief
A healthy 2-month-old boy presented with features of left unilateral lambdoid craniosynostosis, including occipitoparietal flattening, ipsilateral mastoid bulge, contralateral parietal bulge, and ear-level asymmetry; 3D CT confirmed the diagnosis. Through two small incisions, surgeons performed endoscopic suturectomy with seven barrel-stave osteotomies along the suture margins. Estimated blood loss was 10 mL, with no perioperative complications. Helmet therapy began on postoperative day 10. At 4 months, 3D surface scanning showed marked improvement in head shape and symmetry.
What made this case unusual
The technique combined endoscopic suturectomy with barrel-stave osteotomies to provide immediate intraoperative expansion; the report describes this approach in a single patient.
Diagnostic / clinical pearl
In unilateral lambdoid craniosynostosis, the combination of posterior skull asymmetry, mastoid bulge, and ear-level asymmetry can support clinical recognition, with 3D CT confirming the diagnosis.
Why it matters
The favorable short-term result is preliminary; larger case series and long-term follow-up are needed to assess whether adding barrel-stave osteotomies improves outcomes over suturectomy alone.