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12Chapter1IntheRadboudumctwosurgicaloptionsareprovidedtopatientssufferingfromcraniosynostosisendoscopic-assistedcraniosynostosissurgeryincombinationwithhelmettherapyandopenreconstructivesurgeryFigure1Topviewofanormalskull(middle)includingsuturesandfontanelles(brown)Dependingonwhichsutureisaffected(reddotted-lines)craniosynostosiscanleadtovariouscranialmalformationsENDOSCOPIC-ASSISTEDCRANIOSYNOSTOSISSURGERYEndoscopic-AssistedCraniosynostosisSurgery(EACS)incombinationwithpostoperativehelmettherapyisthepreferredtreatmentoptionintheRadboudumc12Duringthissurgicalprocedureasmallopeningiscreatedintheskinandthecranium;thisopeningislargeenoughtoinsertandmanoeuvreanendoscopeinside thecranium(Figure2)Underendoscopic visionastripofbone frombesidethefusedsutureiscarefullyremovedfromundertheskinthroughthesmallincision(s)Inallcasesapost-operativehelmettherapyiscomplementaryanditisinitiatedalmostdirectlyafterthesurgeryTheremoldinghelmetdirectsthecranialgrowthinthedesireddirectiontoobtainnormalizationofthehead13 Thesmallamountofintraoperativebloodloss(around 40ml)andameansurgery timeofabout60minutes12areveryimportantadvantagesofEACS14Sinceonlysmallincisionsarerequiredthescarsaremoderatelysmallandpost-operativeswelling
