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Case 1: Pre-op UTHSCSA
Case 1: 2.5 years post DEAN’S MESSAGE
Case 2: Pre-op
grow in. Skull growth is then guided by custom-fitted helmets that are
worn 23 hours a day over the next 10 – 12 months. Children routinely
go home the next day, with an average hospital stay of one night.

Besides involving less time under anesthesia, less blood loss, and a shorter
hospital stay, Dr. Jimenez also has seen a large decrease in developmental
delays with the new procedure. With the traditional approach, some sur-
geons report as many as 60 percent of patients with delayed development.
The level of developmental delays in Dr. Jimenez’ patients seems to be sig-
nificantly less clinically, and is currently being quantified formally.

Dr. Jimenez attributes developmental delays after the traditional approach
to two key factors: first, the lengthy time before surgery leads to effects on
the underlying brain tissue, and second, the extensive nature of the tradi-
tional procedure, especially the hours of anesthesia and routine replacement
of 100 percent or more of the patient’s blood. He notes that systemic hy-
potension, with concomitant brain hypoperfusion, can certainly lead to brain
dysfunction and developmental problems with these very young brains.

The transfusion rate for the endoscopic procedure is anywhere from
zero to 6 percent, depending on which suture is fused. More than 600
children have had this transformative procedure, and the team has per-
formed as many as six operations in one day. The youngest patient was
a baby born 11 weeks premature and had the surgery on his due date.
They have had zero reoperations.

BARRIERS TO ADOPTION
Surgeons have come from all around the United States and the world

to learn the technique, but the traditional method is still done in the ma-
jority of cases. That the procedure also requires training on new instru-
ments, including endoscopes, is one of the barriers to widespread
adoption. Like many new approaches, this one has seen a slow, but steady
growth curve. The department is now doing a study with a neuropsy-

Case 2: 4.5 years post

Photos courtesy of the School of Medicine at the University of Texas Health Science Center San Antonio Continued on page 28
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