Endoscopic-assisted strip craniectomy using a diamond drill bit attached to a dural retractor: a technical paper

Abstract Background and importance Minimally invasive techniques have largely replaced open cranial vault remodeling as the preferred treatment approach for infants with single-suture craniosynostosis. We describe a refined method for minimizing blood loss during strip craniectomy, using a high-speed drill with a diamond burr and a novel attachable dural retractor. The diamond drill bit generates localized heat that cauterizes the bone edges, thereby potentially reducing bleeding, while the dural retractor is designed to limit heat dissipation and protects the dura from thermal and mechanical injury. Clinical presentation A 3-month-old female infant with trigonocephaly secondary to metopic craniosynostosis underwent endoscopy-assisted metopic strip craniectomy, followed by postoperative cranial molding helmet therapy. The accompanying video demonstrates the operative technique and key steps of the procedure. Conclusion This technical note demonstrates the feasibility of reducing bone-edge blood loss during endoscopic strip craniectomy using a diamond burr equipped with an attachable dural retractor. Further evaluation in larger cohort studies is necessary to objectively assess safety, reproducibility, and impact on perioperative blood loss.