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Comparison of Outcomes between Infants above and below 5 Months of Age Undergoing Endoscopic Craniectomy for Sagittal
Isabella Watson1, Ananth P Abraham1,2, A Hana Miller1
1Division of Neurosurgery, BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Endoscopic strip craniectomy for sagittal suture synostosis in infants aged 5 months or older yielded similar morphological outcomes to earlier interventions. This suggests later treatment is also effective for this common condition.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Pediatrics
Background:
- Sagittal suture synostosis is a common condition requiring timely intervention.
- Endoscopic strip craniectomy with helmet therapy is a standard treatment.
- Optimal timing for intervention is typically considered 3-4 months of age.
Purpose of the Study:
- To evaluate the morphological outcomes of endoscopic strip craniectomy for sagittal suture synostosis in infants aged 5-7 months.
- To compare outcomes in older infants versus younger infants.
- To assess the impact of delayed intervention on cephalic index and reoperation rates.
Main Methods:
- A retrospective analysis of 81 pediatric patients undergoing endoscopic craniectomy for sagittal synostosis (2010-2021).
- Patients were divided into early ( < 5 months) and late (≥ 5 months) intervention groups.
- Morphological indices, helmet therapy duration, and reoperation rates were compared.
Main Results:
- Both early and late intervention groups showed comparable preoperative, postoperative, and 2-year follow-up cephalic indices.
- Average helmeting duration was similar between groups (6.6 vs. 6.1 months).
- No reoperations were needed in the late intervention group; one patient had a poor cosmetic outcome.
Conclusions:
- Endoscopic craniectomy for sagittal suture synostosis in infants over 5 months of age demonstrates comparable morphological outcomes to earlier interventions.
- Delayed surgical intervention does not appear to significantly worsen outcomes.
- This finding supports considering later intervention for sagittal synostosis.
Introduction:
Endoscopic strip craniectomy followed by molding helmet therapy for sagittal suture synostosis is thought to be most effective in infants 3-4 months of age. However, infants often present to a neurosurgeon beyond this time period. The aim of this study was to compare morphological outcomes in older infants (5-7 months of age) with younger infants, in a series of babies who were operated endoscopically for sagittal suture synostosis.
Methods:
The prospectively maintained Pediatric Neurosurgery Clinical Database at BC Children's Hospital was interrogated and 81 pediatric patients who had undergone an endoscopic craniectomy between 2010 and 2021 for sagittal craniosynostosis and had follow-up of at least 1 year were identified. Eleven of these patients received surgical intervention when they were 5 months of age or older (median 5.4 months, range 5.0-6.4). Morphological indices, duration of helmet therapy, and reoperation rates were compared between the early and late intervention groups.
Results:
Both the early intervention (surgery before 5 months of age, n = 70) and the late intervention (surgery at 5 months or later, n = 11) groups had comparable average preoperative cephalic index (CI) (early - 67.1 vs. late - 69.4), change in CI (early - 6.7 vs. late - 4.7), and 2-year follow-up CI (early - 73.8 vs. late - 74.1). Both groups had similar average helmeting duration (6.6 vs. 6.1 months). Of the 11 late intervention patients, none required reoperation but poor cosmetic outcome was noted in 1 patient. The early intervention group had 1 patient who required a secondary cranial vault reconstruction due to persistent scaphocephaly.
Conclusion:
Infants who received an endoscopic craniectomy for sagittal suture synostosis after 5 months of age showed no statistically significant difference in morphological outcomes compared to the early intervention group.
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