Endoscopic versus open treatment for sagittal craniosynostosis: a systematic review and meta-analysis

Sagittal craniosynostosis is the most common form of craniosynostosis. Patients diagnosed with this condition can undergo surgical management using either the conventional open surgery method or the modern approach of minimally invasive endoscope-assisted craniectomy. The present study aimed to compare different outcomes of patients with sagittal craniosynostosis treated with endoscopic procedures versus open surgery. Multiple databases were systematically searched for studies comparing endoscopic and open repair of sagittal craniosynostosis. Outcomes analyzed included estimated blood loss, length of hospital stay, operative time, transfusion rates, complications, reoperations, and cranial indices. Random-effects meta-analyses were performed. Seventeen studies with 2,365 patients were included. Endoscope-assisted surgery showed significantly lower estimated blood loss (mean difference - 118.47 ml), shorter hospital stays (-2.08 days), and reduced operative times (-84.70 min) compared to open surgery. Intraoperative and postoperative transfusion rates were lower with endoscopic treatment (risk ratios 0.22 and 0.30, respectively). Postoperative complications were reduced with endoscopic repair (RR 0.39), without differences in intraoperative complications or reoperations. Preoperative and postoperative cranial indices slightly favored endoscopic approaches. Endoscope-assisted surgery for sagittal craniosynostosis offers perioperative advantages including reduced blood loss, shorter hospitalizations, briefer operative times, lower transfusion needs, and fewer postoperative complications compared to open calvaria remodeling, while achieving comparable cranial reshaping. These findings support an increasing use of minimally invasive endoscopic techniques for repair of sagittal craniosynostosis.