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Impact of age at endoscopic metopic synostosis repair on anthropometric outcomes
Sarah N Chiang1, Erin C Peterson1, David C Lauzier2,3
11Division of Plastic and Reconstructive Surgery, Department of Surgery.
Insights
Delayed endoscopic repair for metopic craniosynostosis shows similar aesthetic outcomes at one year. Age at endoscopic strip craniectomy does not significantly impact frontal width or interfrontal divergence angle at one year post-surgery.
Area of Science:
- Craniofacial surgery
- Pediatric neurosurgery
- Plastic surgery
Background:
- Metopic craniosynostosis is a premature fusion of the metopic suture.
- Endoscopic strip craniectomy is a common surgical approach for correction.
- Optimal timing for endoscopic repair, particularly regarding age, is still under investigation.
Purpose of the Study:
- To evaluate the aesthetic outcomes of endoscopic strip craniectomy for metopic craniosynostosis in patients treated after 4 months of age compared to those treated earlier.
- To determine if delayed repair impacts key facial measurements at one year post-operation.
Main Methods:
- Retrospective analysis of a metopic synostosis database.
- Patients were divided into two groups: <4 months and ≥4 months at repair.
- Frontal width and interfrontal divergence angle (IFDA) were measured from CT scans at 1-year follow-up.
Main Results:
- The study included 28 patients <4 months and 8 patients ≥4 months old at repair.
- No significant difference in 1-year postoperative IFDA or frontal width was observed between the age groups.
- Perioperative complications and patient sex did not differ between groups.
Conclusions:
- One-year aesthetic outcomes, measured by IFDA and frontal width, are comparable for endoscopic metopic craniosynostosis repair performed before or after 4 months of age.
- Longer-term studies are needed to confirm the durability of these findings until skeletal maturity.
Objective:
Endoscopic strip craniectomy for metopic craniosynostosis relies on rapid growth and postoperative helmeting for correction. Endoscopic repair is generally performed before patients reach 4 months of age, and outcomes in older patients have yet to be quantified. Here, the authors examined a cohort of patients treated with endoscopic repair before or after 4 months of age to determine aesthetic outcomes of delayed repairs.
Methods:
Data from eligible patients were retrospectively assessed and aggregated in a dedicated metopic synostosis database. Inclusion criteria were radiographically confirmed metopic synostosis and endoscopic treatment. Patients were dichotomized into two groups: those younger than 4 months and those 4 months or older at the time of repair. The frontal width and interfrontal divergence angle (IFDA) were measured on reconstructed CT images. These measurements, alongside operative time, estimated blood loss, and transfusion rates, were compared between groups using the Student t-test or chi-square test.
Results:
The study population comprised 28 patients treated before 4 months of age and 8 patients treated at 4-6 months of age. Patient sex and perioperative complications did not differ by age group. Older age at repair was not significantly associated with 1-year postoperative IFDA (140° ± 4.2° vs 142° ± 5.0°, p = 0.28) or frontal width (84 ± 5.2 vs 83 ± 4.4 mm, p = 0.47).
Conclusions:
One-year postoperative IFDA and frontal width do not differ significantly between patients treated before and after 4 months of age. Further study with longer follow-up is necessary to confirm the longevity of these results at skeletal maturity.
