Optimal timing of endoscopic sagittal suturectomy

Area of Science:

• Pediatric Neurosurgery
• Craniofacial Surgery
• Infant Health

Background:

• Sagittal craniosynostosis is a common condition in infants.
• Endoscopic sagittal suturectomy (ESS) is a standard treatment.
• Optimal surgical timing for ESS is debated, with many favoring <3 months.

Purpose of the Study:

• To determine if infant age at ESS surgery impacts craniometric correction.
• To assess if older infants (>3 months) have less correction.
• To investigate age-related differences in blood transfusion rates.

Main Methods:

• Retrospective review of 107 infants undergoing ESS for sagittal craniosynostosis (2009-2023).
• Patients stratified by age groups (0-2, 2-3, >3 months) to compare outcomes.
• Receiver operating characteristic (ROC) analysis to identify optimal age cutoffs.

Main Results:

• Infants >3 months showed less cephalic index (CI) correction at final follow-up (25.0% vs 61.5%, p=0.031).
• Older infants (>3 months) had reduced mean CI change and helmet discontinuation rates.
• Younger infants (median 2 months) were more likely to require transfusion (p=0.028).

Conclusions:

• ESS may still benefit infants >3 months old with sagittal craniosynostosis.
• Optimal age for ESS and factors influencing outcomes require further study.
• Age cutoffs of 3.75 months for CI correction and 2.75 months for transfusion avoidance were identified.