Endoscopic intracranial craniofacial and monobloc osteotomies with the aidof a malleable high-speed pneumatic drill: A cadaveric and clinical study

Endoscopic techniques are now an accepted part of the surgical armamentariu m and are used routinely in a number of aesthetic and reconstructive proced ures. Endoscopic techniques are now being used commonly by plastic surgeons in forehead and face lifts. In both craniofacial surgery and in neurosurge ry, the application of endoscopy potentially allows the surgical team to pe rform wide dissection of the dura mater in a minimally invasive fashion, th ereby potentially reducing the risk of dural and brain injury. Also reduced by this surgical approach is potential injury to the major venous structur es, such as the sagittal sinus, along with overall reduced bleeding. After an extensive laboratory study of 10 cadaveric dissections, the authors have refined a new endoscopic technique for completing an endoscopic intracrani al craniofacial osteotomy. This study was conducted in the Department of Pa thology at the University of Brno (Czech Republic), and was performed as a cooperative multicenter project between the University of Palermo, the Albe rt Einstein College of Medicine/Montefiore Medical Center, the Hospital Inf antil de Mexico, "Federico Gomez," and the Medtronic Midas Rex Institute, ( Fort Worth, TX). During this cadaveric anatomic study and using small treph inations and skin incisions the authors were able to develop several differ ent craniofacial and endoscopic monobloc procedures. To accomplish intracra nial and facial osteotomies, a new malleable high-speed drill was designed for use in the endoscopic craniofacial approach. Using these newly develope d cadaveric techniques and instrumentation, the authors performed two intra cranial craniofacial procedures on children with congenital craniofacial an omalies. There would appear to be several significant advantages for the cr aniofacial patient as result of these new techniques: reduced surgical trau ma, operative bleeding, surgical time, and hospitalization, along with a re duced risk of infection. It became quickly apparent, as a result of these c adaveric studies, that the learning curve for this endoscopic procedure is quite steep.