Addressing unilateral lambdoid craniosynostosis using endoscopic suturectomy and barrel-stave osteotomies: surgical technique and literature review.

PURPOSE: Unilateral lambdoid craniosynostosis (ULC) is a rare cranial deformity requiring intervention to correct asymmetry of the posterior skull. Conventional open remodeling and distraction osteogenesis offer robust expansion but carry risks of higher blood loss, hardware complications, or reoperation. We report a novel, minimally invasive technique combining endoscopic lambdoid suturectomy with barrel-stave osteotomies, supplemented by a literature review.

CASE DESCRIPTION: A 2-month-old healthy male presented with classic left ULC features, including occipitoparietal flattening, ipsilateral mastoid bulge, contralateral parietal bulge, and ear level asymmetry, confirmed by 3D computed tomography. Under endoscopic guidance through two small incisions, a 10-cm-long by 1.2-cm-wide lambdoid suturectomy was performed. To enhance immediate intraoperative expansion, seven 3-cm barrel-stave osteotomies were placed perpendicularly along the superior (4 cuts) and inferior (3 cuts) suture margins and gently greenstick-fractured outward. The estimated blood loss was 10 mL without perioperative complications. Postoperative cranial molding helmet therapy was initiated on day 10. At the 4-month follow-up visit, 3D surface scanning demonstrated marked improvement in head shape and symmetry.

CONCLUSIONS

Our method, endoscopic suturectomy and barrel-stave osteotomies on a single patient with unilateral lambdoid craniosynostosis, demonstrated safe and favorable outcomes. We believe the addition of barrel-stave osteotomies to suturectomy may yield superior clinical outcomes, compared to conventional endoscopic-assisted procedures with suturectomy alone. However, it is necessary to accumulate a larger number of cases and conduct long-term follow-up studies to further validate this hypothesis.