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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.
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.
