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Minimally Invasive Endoscopic Surgery for Infantile Craniosynostosis: A Longitudinal Cohort Study
Coleman P Riordan1, David Zurakowski2, Petra M Meier3
1Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Insights
Endoscopic strip craniectomy (ESC) offers a safe and effective treatment for infantile craniosynostosis, normalizing head growth with low complication rates. This minimally invasive approach provides a viable alternative to open surgery for affected infants.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Craniosynostosis, the premature fusion of cranial sutures, affects infant head development.
- Minimally invasive endoscopic strip craniectomy (ESC) is an alternative to open surgery for treating craniosynostosis.
- Evaluating patient outcomes and long-term efficacy of ESC is crucial for surgical decision-making.
Purpose of the Study:
- To assess patient outcomes following minimally invasive endoscopic strip craniectomy (ESC) for infantile craniosynostosis.
- To identify risk factors associated with blood transfusion in infants undergoing ESC.
- To evaluate the effectiveness of ESC in normalizing head circumference in infants.
Main Methods:
- Retrospective cohort analysis of 500 infants treated with ESC and orthotic therapy (2004-2018).
- Analysis of operative outcomes including transfusions, complications, reoperations, and head circumference changes.
- Statistical methods included multivariable logistic regression, paired t tests, and Fisher exact test.
Main Results:
- ESC demonstrated low rates of blood transfusion (6.6%), complications (1.4%), and reoperations (3.0%).
- Syndromic craniosynostosis and multiple fused sutures were risk factors for transfusion.
- Head circumference normalized by 12 months in infants with sagittal, coronal, and multisuture craniosynostosis.
Conclusions:
- Endoscopic strip craniectomy (ESC) is a safe, effective, and durable treatment for infantile craniosynostosis.
- ESC achieves head growth normalization with minimal risks, offering an advantage over open reconstruction.
- Early diagnosis and prompt referral enable timely consideration of ESC for eligible infants.
Objective:
To evaluate patient outcomes of minimally invasive endoscopic strip craniectomy (ESC) for craniosynostosis.
Study Design:
This is a retrospective cohort analysis (2004-2018) of 500 consecutive infants with craniosynostosis treated by ESC with orthotic therapy at a single center. Operative outcomes included transfusions, complications, and reoperations as well as head circumference change based on World Health Organization percentiles. Multivariable logistic regression was used to identify risk factors associated with blood transfusion. Paired t tests were used for within-patient comparisons and Fisher exact test to compare syndromic and nonsyndromic subgroups.
Results:
ESC was associated with low rates of blood transfusion (6.6%), complications (1.4%), and reoperations (3.0%). Risk factors for transfusion included syndromic craniosynostosis (P = .01) and multiple fused sutures (P = .02). Median surgical time was 47 minutes, and hospital length of stay 1 day. Transfusion and reoperation rates were higher among syndromic patients (both P < .001). Head circumference normalized by 12 months of age relative to World Health Organization criteria in infants with sagittal, coronal, and multisuture craniosynostosis (all P < .001).
Conclusions:
ESC is a safe, effective, and durable correction of infantile craniosynostosis. ESC can achieve head growth normalization with low risks of blood transfusion, complications, or reoperation. Early identification of craniosynostosis in the newborn period and prompt referral by pediatricians allows families the option of ESC vs larger and riskier open reconstruction procedures.
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