Comparison of Esthetic Outcomes After Endoscopic versus Open Treatment for Sagittal Craniosynostosis According to...

The esthetic outcome is one of the major determinants in the performance of surgical corrections of sagittal craniosynostosis. Parental satisfaction is underreported in literature, and we used a modified Whitaker classification (Lausanne classification) to improve the stratification of esthetic outcomes. The aim of this paper is to compare the esthetic results of open remodeling surgery (ORS) versus endoscope-assisted suturectomy (EAS) for the correction of sagittal craniosynostosis for both surgeons and parents and to validate Lausanne classification.

Pediatric patients diagnosed with sagittal craniosynostosis and operated on by ORS or EAS between 2012 and 2022 were included. The esthetic satisfaction was assessed using a modified version of the Whitaker classification, namely the Lausanne classification. Epidemiology and clinical and surgical outcomes were retrieved from electronic records and analyzed for the two groups.

Forty patients were included in the study. Mean age at surgery was 3.4 months (± standard deviation 0.6) for the EAS group and 7.0 months (± standard deviation 2.0) for the ORS group (P < 0.0001). Esthetic results were significantly better for the EAS than the ORS for both parents (P = 0.0014) and surgeons (P = 0.0013). Overall length of hospitalization and length of stay at intensive care unit were significantly shorter for the EAS than the ORS group (P < 0.0001 and P = 0.0007, respectively). We observed no differences in complication rates between the two cohorts.

EAS treatment for sagittal craniosynostosis is a safe technique with better esthetic results for both parents and surgeons according to Lausanne classification and shorter lengths of stay.