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Isolated Sagittal Craniosynostosis and Open or Endoscopic Cranial Vault Remodeling: An Evaluation of Developmental
Ethan D Paliwoda1, Mason J Horne1, Ishan Patel1
1Albany Medical College, Albany Medical Center, Albany, NY.
Insights
Endoscopic strip craniectomy for craniosynostosis shows better outcomes than open surgery. This minimally invasive approach leads to fewer developmental delays and shorter hospital stays for children.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Developmental Pediatrics
Background:
- Craniosynostosis, premature cranial suture fusion, can impede brain development and cause delays.
- Treatment options include open cranial vault remodeling and endoscopic strip craniectomy.
- This study evaluates developmental outcomes comparing these two surgical methods for isolated sagittal craniosynostosis.
Purpose of the Study:
- To compare the developmental outcomes of open cranial vault remodeling versus endoscopic strip craniectomy in infants with isolated sagittal craniosynostosis.
- To assess differences in surgical, postoperative, and hospital stay parameters between the two treatment groups.
- To identify potential benefits of endoscopic intervention regarding long-term developmental trajectories.
Main Methods:
- Retrospective cohort study of 45 patients with isolated sagittal craniosynostosis treated between 2013 and 2024.
- Patients were divided into two groups: open cranial vault remodeling (n=17) and endoscopic strip craniectomy (n=28).
- Data included demographics, surgical details, postoperative outcomes, and developmental assessments via progress notes.
Main Results:
- The open surgery group was older and had significantly higher rates of intraoperative drains, longer procedures, greater blood loss, extended hospital stays, and increased opioid prescriptions.
- Postoperatively, the open surgery group showed higher incidences of social delays (19% vs. 0%) and cognitive delays (31% vs. 4%) within 12 months compared to the endoscopic group.
- Endoscopic strip craniectomy demonstrated superior hemodynamic, postoperative, and hospital stay outcomes.
Conclusions:
- Endoscopic cranial vault remodeling offers preferential advantages in hemodynamic stability, postoperative recovery, and hospital duration.
- While limited by sample size, findings suggest a potential benefit of endoscopic intervention for improved developmental outcomes in craniosynostosis.
- Further research with larger cohorts is warranted to confirm long-term developmental benefits.
Background:
Craniosynostosis, a condition involving the premature fusion of cranial sutures, can impair brain development and potentially lead to developmental delays. This study compares open cranial vault remodeling versus endoscopic strip craniectomy treatment for isolated sagittal craniosynostosis, primarily focusing on development outcomes.
Methods:
A retrospective cohort study was conducted at a tertiary pediatric surgery center, involving all 45 patients treated surgically for isolated sagittal craniosynostosis from 2013 to 2024. Patients were categorized into 2 groups based on surgical intervention: open cranial vault remodeling (n=17) and endoscopic strip craniectomy (n=28). Data collected included patient demographics, intraoperative specifics, and postoperative outcomes. Developmental outcomes were assessed using postoperative progress notes.
Results:
Of the 45 patients, those undergoing open surgery were older (10.7 mo and 9.4 kg versus 3.3 mo and 6.4 kg, P <0.001) and experienced higher use of intraoperative drains (65% versus 0%, P <0.001), more prolonged procedures (189 versus 58 min, P <0.001), more significant blood loss (102 versus 62 mL, P =0.009), longer stays (3.3 versus 2.6 d, P =0.011), and higher opioid prescription rates (82% versus 43%, P =0.013) compared to the endoscopic group. Within 12 months postoperatively, social delays were more common in the open group (19 versus 0%, P =0.049), and, postoperatively in general, cognitive delays were more common in the open group (31% versus 4%, P =0.023) when compared to the endoscopic group.
Conclusions:
Endoscopic cranial vault remodeling produces preferentially better hemodynamic, postoperative, and hospital stay outcomes. Although inferences into long-term developmental delay outcomes were limited due to sample size, a preferential benefit toward endoscopic intervention may exist.
