Endoscopic Techniques in Sagittal Synostosis Correction: A Systematic Review and Meta-Analysis

Scaphocephaly is a craniofacial deformity caused by the premature fusion of the sagittal suture, which can affect skull growth and shape. For decades, surgical treatment or craniosynostosis has involved open procedures, ranging from the removal of a single suture to complex cranial remodeling techniques with large skin incisions. Since the 1990s, endoscopic approaches have emerged as potentially less invasive options. This study aimed to evaluate the efficacy of and differences between endoscopic scaphocephaly correction techniques.

A comprehensive search was conducted on PubMed, Embase, Web of Science, and Scopus for clinical trials and observational studies analyzing endoscopic correction of scaphocephaly and describing the procedure. The outcomes analyzed included pre- and postoperative cephalic indexes, operation time, blood loss, number of transfusions, complications, and subgroup analysis.

Thirty-two studies involving 1566 patients (mean age at the time of surgery: 3.3 months) were included. Overall, the cephalic index showed a significant increase in the mean difference of 7.58 (95% CI 6.35-8.80; P < .01), and when analyzed by subgroups based on the size of the removed strip (≤2 and >2 cm), there was no significant difference in the cephalic index. In addition, the analysis of lateral osteotomies showed no difference in CI between the subgroups.

Our results suggest that less invasive techniques, involving smaller incisions and excisions, can achieve comparable success with traditional techniques. These findings have significant implications for clinical practice, underscoring the importance of exploring less invasive options for scaphocephaly correction to improve patient outcomes and reduce morbidity.