{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T09:19:26Z","timestamp":1770887966987,"version":"3.50.1"},"reference-count":41,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Combined metopic-sagittal craniosynostosis is traditionally treated with open cranial vault remodeling and fronto-orbital advancement, sometimes in multiple operations. Endoscopic treatment of this multisuture synostosis presents a complex challenge for the surgeon and orthotist.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors retrospectively analyzed the preoperative and 1-year postoperative CT scans of 3 patients with combined metopic-sagittal synostosis, all of whom were treated with simultaneous endoscope-assisted craniectomy of the metopic and sagittal sutures followed by helmet therapy. Established anthropometric measurements were applied to assess pre- and postoperative morphology, including cranial index and interfrontal divergence angle (IFDA). Patients\u2019 measurements were compared to those obtained in 18 normal controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Two boys and one girl underwent endoscope-assisted craniectomy at a mean age of 81 days. The mean preoperative cranial index was 0.70 (vs control mean of 0.82, p = 0.009), corrected postoperatively to a mean of 0.82 (vs control mean of 0.80, p = 0.606). The mean preoperative IFDA was 110.4\u00b0 (vs control mean of 152.6\u00b0, p = 0.017), corrected postoperatively to a mean of 139.1\u00b0 (vs control mean of 140.3\u00b0, p = 0.348). The mean blood loss was 100 mL and the mean length of stay was 1.7 days. No patient underwent reoperation. The mean clinical follow-up was 3.4 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Endoscope-assisted craniectomy with helmet therapy is a viable single-stage treatment option for combined metopic-sagittal synostosis, providing correction of the stigmata of trigonoscaphocephaly, with normalization of the cranial index and IFDA.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2020.2.peds2029","type":"journal-article","created":{"date-parts":[[2020,4,17]],"date-time":"2020-04-17T07:06:06Z","timestamp":1587107166000},"page":"113-121","source":"Crossref","is-referenced-by-count":10,"title":["Endoscopic treatment of combined metopic-sagittal craniosynostosis"],"prefix":"10.3171","volume":"26","author":[{"given":"Ema","family":"Zubovic","sequence":"first","affiliation":[{"name":"Division of Plastic & Reconstructive Surgery, Department of Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary B.","family":"Skolnick","sequence":"additional","affiliation":[{"name":"Division of Plastic & Reconstructive Surgery, Department of Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sybill D.","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Division of Plastic & Reconstructive Surgery, Department of Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Bellanger","sequence":"additional","affiliation":[{"name":"Orthotic and Prosthetic Lab, St. Louis, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew D.","family":"Smyth","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine in St. Louis; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamlesh B.","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Plastic & Reconstructive Surgery, Department of Surgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"1325e","DOI":"10.1097\/PRS.0000000000003371","article-title":"The management of trigonoscaphocephaly as a result of combined metopic and sagittal synostosis","volume":"139","author":"Dobbs TD","year":"2017","unstructured":"Dobbs TD, Salahuddin O, Jayamohan J,  The management of trigonoscaphocephaly as a result of combined metopic and sagittal synostosis. 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