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School-Aged Anthropometric Outcomes After Endoscopic or Open Repair of Metopic Synostosis
Austin Y Ha1, Gary B Skolnick1, David Chi1
1Division of Plastic and Reconstructive Surgery, Department of Surgery and.
Insights
Endoscopic repair for metopic craniosynostosis offers equivalent or superior 5-year outcomes compared to open surgery, with reduced morbidity and faster recovery. This approach is recommended for infants under six months.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Plastic Surgery
Background:
- Metopic craniosynostosis is a premature fusion of the metopic suture.
- Treatment options include fronto-orbital advancement (open repair) and endoscopic strip craniectomy.
- Endoscopic repair is typically indicated for infants under 6 months.
Purpose of the Study:
- To compare 5-year anthropometric outcomes of endoscopic versus open repair for metopic craniosynostosis.
- To evaluate peri-operative variables and long-term morbidity associated with each surgical technique.
Main Methods:
- Retrospective chart review of 31 nonsyndromic patients with isolated metopic craniosynostosis.
- Comparison of frontal width, interfrontal divergence angle, Whitaker classification, and lateral frontal retrusion at 5 years.
- Analysis of peri-operative data including blood loss, transfusion rates, length of stay, and operative time.
Main Results:
- Endoscopic repair showed a significantly lower rate of lateral frontal retrusion at 5 years.
- No significant differences were observed in other anthropometric outcomes between the groups.
- The endoscopic group experienced shorter operating times, hospital stays, and less blood loss.
Conclusions:
- Endoscopic repair provides superior or equivalent anthropometric outcomes and reduced morbidity in school-aged children with metopic craniosynostosis.
- Endoscopic repair is associated with a faster recovery and decreased complications.
- Consider endoscopic repair for metopic craniosynostosis in infants diagnosed before 6 months of age.
Background And Objectives:
Metopic craniosynostosis can be treated by fronto-orbital advancement or endoscopic strip craniectomy with postoperative helmeting. Infants younger than 6 months of age are eligible for the endoscopic repair. One-year postoperative anthropometric outcomes have been shown to be equivalent, with significantly less morbidity after endoscopic treatment. The authors hypothesized that both repairs would yield equivalent anthropometric outcomes at 5-years postoperative.
Methods:
This study was a retrospective chart review of 31 consecutive nonsyndromic patients with isolated metopic craniosynostosis treated with either endoscopic or open correction. The primary anthropometric outcomes were frontal width, interfrontal divergence angle, the Whitaker classification, and the presence of lateral frontal retrusion. Peri-operative variables included estimated blood loss, rates of blood transfusion, length of stay, and operating time.
Results:
There was a significantly lower rate of lateral frontal retrusion in the endoscopic group. No statistically significant differences were found in the other 3 anthropometric outcomes at 5-years postoperative. The endoscopic group was younger at the time of surgery and had improved peri-operative outcomes related to operating time, hospital stay and blood loss. Both groups had low complication and reoperation rates.
Conclusions:
In our cohort of school-aged children with isolated metopic craniosynostosis, patients who underwent endoscopic repair had superior or equivalent outcomes on all 4 primary anthropometric measures compared with those who underwent open repair. Endoscopic repair was associated with significantly faster recovery and decreased morbidity. Endoscopic repair should be considered in patients diagnosed with metopic craniosynostosis before 6 months of age.
