**11. Endoscopic operation for craniosynostosis**

Jimenez and colleagues [134, 135] pioneered MIS treatment of craniosynostosis. Endoscopy-assisted craniosynostosis surgery (EACS) before the age of 6 months can correct this condition while combined with postoperative helmet molding therapy. The optimal age for EACS is 3 months. The procedure is essentially strip craniectomy and can be carried out with a standard surgical instrument and a 0° endoscope with a working shaft used for endoscopic facial lift surgery without irrigation.

In scaphocephaly, the craniectomy is performed from the anterior fontanelle to the posterior one. The softer skull bone at this young age can be cut with strong scissors. The removed strip should be 4–5 cm wide and 11 cm long. Lateral barrel stave osteotomies or wedge-shaped osteotomies can be added behind the coronal suture and in front of the lambdoid sutures. Moreover the complication rate is reportedly low. Blood transfusion was required only in 9% of 139 patients. The children required to wear a helmet within 3 weeks postoperatively for 10 months. Special attention is given for possible pressure ulcerations or eczema, but skin complications are rare [2, 7, 135]. The reported studies showed that endoscopic approach has a good outcome with low reported complication rate and good success rate.
