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Neurodevelopmental Outcomes Following Open and Endoscopic Repair of Isolated Sagittal, Coronal, Metopic, and Lambdoid
Ethan D Paliwoda1, Ishan S Patel1, Mason J Horne1
1Division of Plastic Surgery, Department of Surgery.
Insights
Endoscopic strip craniectomy offers faster recovery for craniosynostosis but may increase developmental delay risk. Age and drain placement also impact outcomes, requiring careful consideration for pediatric neurosurgery.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Pediatrics
Background:
- Craniosynostosis involves premature cranial suture fusion, potentially hindering child development.
- This study evaluates open cranial vault remodeling versus endoscopic strip craniectomy with helmet therapy for isolated craniosynostosis.
Purpose of the Study:
- To compare perioperative outcomes and neurodevelopmental results between open and endoscopic surgical approaches for craniosynostosis.
- To identify risk factors for postoperative developmental delay in pediatric patients.
Main Methods:
- Retrospective analysis of 89 pediatric patients with isolated craniosynostosis over 13 years.
- Comparison of operative variables (blood loss, operative time, hospital stay) and neurodevelopmental assessments between endoscopic (n=44) and open (n=45) repair groups.
Main Results:
- Endoscopic repair showed significant perioperative advantages: less blood loss, shorter operative time, reduced hospital stay, and fewer opioid prescriptions.
- Overall developmental delay rates were similar between groups (29.3% endoscopic vs. 20.9% open).
- Isolated coronal and metopic synostosis, endoscopic intervention, older age at surgery, and drain placement were independently associated with increased odds of developmental delay.
Conclusions:
- Endoscopic repair provides perioperative benefits for craniosynostosis treatment.
- However, endoscopic intervention, patient age, and drain placement may be independent predictors of postoperative developmental delay.
Background:
Craniosynostosis, characterized by premature fusion of cranial sutures, can impede childhood development. This study compares outcomes between open cranial vault remodeling and endoscopic strip craniectomy with helmet therapy in children with isolated craniosynostosis of the sagittal, metopic, coronal, and lambdoid sutures.
Methods:
Retrospectively, 89 patients treated over 13 years were analyzed; 44 underwent endoscopic repair, and 45 underwent open surgery. Key operative variables including intraoperative blood loss, operative time, transfusion rates, and hospital stay were analyzed. Neurodevelopment was assessed at multiple postoperative intervals.
Results:
The endoscopic group experienced significant perioperative advantages with lower mean intraoperative blood loss (58.84 mL vs. 107.61 mL, P < 0.001), reduced operative time (96 minutes vs. 244 minutes, P < 0.001), shorter hospital stays (2.67 days vs. 4.07 days, P < 0.001), and reduced opioid prescription rates (40.9% vs. 71.1%; P = 0.004) compared to the open group. Overall developmental delay rates were similar (29.3% vs. 20.9%, P = 0.378). However, those with isolated coronal synostosis (OR, 4.81, P = 0.057) and isolated metopic synostosis (OR, 16.73; P = 0.005) had increased odds of developmental delay compared to those with sagittal synostosis. Endoscopic intervention (OR, 11.32; P = 0.044), each additional month of age at surgery (OR, 1.25; P = 0.026), and drain placement (OR, 12.59; P = 0.018) were each independently and significantly associated with greater odds of delay.
Conclusions:
Endoscopic repair may offer perioperative benefits yet may be an independent predictor of postoperative developmental delay alongside age and drain placement.
