Related Experiment Video
Updated: May 16, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Evaluating Surgical Techniques for Craniosynostosis: A Systematic Review and Meta-Analysis on Endoscopic Approach
Fernando De Nigris Vasconcellos1,2, Fabricio Garcia-Torrico3, Victor Hugo Cardoso Betta2
1Department of Neurosurgery, Boston Medical Center, Boston , USA.
Insights
Endoscopic surgery for craniosynostosis significantly reduces blood transfusions, hospital stays, and surgery time compared to open surgery. Long-term head shape outcomes are similar, but neurocognitive effects require further study.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Medical Technology
Background:
- Craniosynostosis involves premature cranial suture closure, causing abnormal head shape and potential complications.
- Traditional open surgery is common, but minimally invasive endoscopic approaches (EA) are emerging.
- This review compares EA with open surgery for craniosynostosis treatment.
Purpose of the Study:
- To compare the safety and clinical outcomes of endoscopic surgery versus open surgery for craniosynostosis.
- To evaluate postoperative recovery metrics, including blood loss and hospital stay.
- To assess long-term cranial shape correction and identify areas for future research.
Main Methods:
- Systematic review and meta-analysis of 34 studies with 11,554 patients.
- PRISMA guidelines followed for data extraction and analysis.
- Primary outcomes: blood transfusion rates and volume. Secondary outcomes: surgical time, hospital/ICU stay, cephalic index, and reoperation rates.
Main Results:
- Endoscopic surgery (EA) showed significantly lower blood transfusion rates and volume.
- EA resulted in shorter hospital stays, ICU stays, and overall surgical times.
- Comparable cephalic index outcomes were observed, with EA having substantially lower reoperation rates.
Conclusions:
- Endoscopic surgery is a less invasive option for craniosynostosis with improved recovery metrics.
- Both EA and open surgery yield similar long-term cranial shape results.
- Individualized treatment is key, and further research into neurocognitive outcomes is warranted.
Background And Objectives:
Craniosynostosis is a congenital condition where premature closure of cranial sutures leads to abnormal head shapes, potential neurocognitive deficits, and increased intracranial pressure. Surgery is frequently recommended to prevent complications, with open surgery being the traditional approach. Recently, endoscopic surgery (endoscopic approach [EA]) has emerged as a minimally invasive alternative. The aim of this review was to compare the outcomes of these techniques in craniosynostosis, focusing on safety, clinical results, and postoperative recovery.
Methods:
A systematic review and meta-analysis were performed, following PRISMA guidelines. Data from 34 studies, involving 11 554 patients, were analyzed. Primary outcomes included blood transfusion requirements and volume, whereas secondary outcomes assessed surgical time, hospital and intensive care unit (ICU) stay, and cephalic index. ROBINS-I was used for bias assessment.
Results:
EA was associated with significantly lower blood transfusion rates (risk ratio: 4.09, 95% CI: 2.66-6.29, P < .00001) and reduced transfused blood volume (mean difference [MD]: 153.35 mL, 95% CI: 107.99-198.72, P < .00001) compared with open surgery. Hospital stays were shorter in the EA group (MD: 2.79 days, 95% CI: 2.15-3.44, P < .00001), as were ICU stays (MD: 1.49 days, 95% CI: 1.03-1.94, P < .00001). EA also led to shorter surgeries (MD: 128.63 minutes, 95% CI: 112.07-145.19, P < .00001). There were no significant differences in the cephalic index (standardized mean difference: 0.32, 95% CI: -0.37 to 1.00, P = .37). Reoperation rates were 62% lower in EA (risk ratio = 0.38, 95% CI: 0.22 to 0.66, P = .0006).
Conclusion:
Endoscopic surgery offers a less invasive option with reduced transfusion needs, shorter hospital and ICU stays, and shorter surgery times. Both methods result in comparable long-term cranial shape outcomes, emphasizing individualized treatment. Further research is needed to explore long-term neurocognitive effects.
