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GeneralIntroduction131iskepttoaminimumThemajorityofpatientsaredischargedthemorningafterthesurgerywithoutintensivecareunitstayParentalconcernsandfamilyanxietyaresignificantlylowerincomparisontootherprocedures1516EACSandhelmettherapyisgenerallyusedforyoungchildrenbelowtheageof6monthsThisisbecausethenormalandfastexpansionofthebrainwhichisimportantduringremoldinghelmettherapygraduallyreducesatlaterage17InadditionthethicknessofthebonethatsurroundsthefusedsutureincreasesmakingithardertocutandswiftlyremovethebonepiecethroughthesmallincisionsThereforeopenreconstructivesurgeryisabetterfittingtreatmentoptionforolderpatientsFigure2TopviewofendoscopicassistedcraniectomyA)Theredareaindicatesthebonestripthatsurroundsthefusedsagittalsuture(yellowdottedline)undertheskinofascaphocephalypatientThecoronalandlambdoidsuturesaremarked(black)B)Twosmallincisionsaremadeintheskinandskull(yellowboxes)UnderendoscopicguidancethebonestripiscutfrombothsidesC)RemovalofthebonestripOPENRECONSTRUCTIVESURGERYOpencranialvaultreconstructionisideallyperformedaroundtheageof10monthsorlaterDuringthisprocedureabicoronal(ear-to-ear)incisionismadeandskinandperiostarestrippedfromthecraniumNextthepartsofthecraniumthatareaffectedbythecraniosynostosisaredissectedandtemporallyremovedfromthepatientThesepartsarereconstructedintoanewshapeTheaimistocreatealargercraniumwithanaestheticallyimprovedshapeWithresorbablefixationmaterialthedissectedandreconstructedbonepiecesareplacedbackintothepatientAnillustrationofanopencranialvaultreconstructionisshown
