A Novel Virtual Surgical Planning Technique Improves Outcomes in Endoscopic Suturectomy for Coronal Craniosynostosis

Endoscopic suturectomy is increasingly favored over open cranial vault reconstruction for coronal synostosis patients due to decreased morbidity. However, ensuring an accurate craniectomy is challenging due to anatomical changes inherent to coronal synostosis. Given the improved intraoperative efficiency and postoperative outcomes previously seen with the use of virtual surgical planning (VSP) in traditional open craniosynostosis correction, we sought to utilize VSP to optimize the endoscopic correction of coronal craniosynostosis.

Patients who underwent endoscopic-assisted suturectomy for unicoronal or bicoronal craniosynostosis from 2020 to 2024 were retrospectively reviewed. In one cohort, a surface marking guide was developed with VSP to facilitate percutaneous tattooing of the periosteum. These marks were then followed to confirm craniectomy completion after subgaleal exposure. The VSP- and non-VSP-guided cohorts were compared for patient demographics, estimated blood loss, operative time, and length of stay.

Seventeen patients were included who underwent 12 unilateral and 5 bilateral suturectomies. Eight patients (4 unicoronal and 4 bicoronal) compared to 9 patients (8 unicoronal and 1 bicoronal) were in the VSP and non-VSP cohorts, respectively. Overall EBL for unilateral cases was 12.1 ± 7.5 mL. Patients who underwent VSP had equivalent EBL to the non-VSP cohort (10.0 ± 1.0 mL vs 13.1 ± 19.2 mL, P  = 0.53). For bilateral cases, EBL for the VSP cohort was 28.8 ± 30.9 mL compared to 50 mL for the one bilateral non-VSP guided case. Patients who had VSP guidance had significantly reduced operative time for unilateral cases (63±17 vs 81± 20 minutes, P  < 0.01). For bilateral cases, VSP guidance was 78 ± 26 minutes compared to 118 minutes for the one bilateral case with non-VSP guidance.

Using VSP to assist endoscopic coronal suturectomy reduces operative time, which may reflect a decreased reliance on intraoperative assessment and increased fidelity of neosuture placement.