Endoscope-assisted release for pancraniosynostosis with delayed single-suture refusion managed with endoscopic re-release in the same patient: illustrative case

BACKGROUND Endoscopic release for craniosynostosis is safe and effective. It has decreased surgical time, hospital stay, and blood loss compared to open techniques. However, its use in multisuture synostosis or suture refusion is limited. This is likely due to surgeon preference and lack of supportive data in the literature on these less common conditions. OBSERVATIONS The authors present a case of bicoronal, bilambdoid, and sagittal craniosynostosis with elevated intracranial pressure (ICP), treated with endoscopic release and postoperative cranial orthosis. Following the initial release, asymmetry of the right occipital region was noted. Refusion of the right lambdoid suture was then confirmed on imaging. Endoscopic re-release was performed with continued cranial orthosis postoperatively. The patient showed improved cranial symmetry, appropriate head growth, and ongoing ICP normalization. LESSONS Endoscopic release for multisuture craniosynostosis was effective in improving cranial asymmetry and decreasing ICP. Close clinical follow-up with laser scans helped identify worsening cranial asymmetries that indicated a refusion. Endoscopic re-release can be considered an option for refusion in infants with good results. ICP remained within normal limits after endoscopic release.