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Is Endoscopic Treatment of Sagittal Craniosynostosis in Children Aged 6 to 9 Months an Effective Approach for Delayed
Vincent Aquino1, Alondra Arias2, Caleb Morales2
1Assistant Professor, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, Buffalo, NY; Pediatric Craniomaxillofacial Surgeon, Department of Craniofacial Surgery, Craniofacial Center of Western New York, John Oishei Children's Hospital, Buffalo, NY.
Insights
Endoscopic-assisted craniectomy for sagittal craniosynostosis in infants 6-9 months old shows high success rates. This minimally invasive approach offers a viable alternative to open repair for older infants, with significant reductions in intracranial pressure observed.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Minimally Invasive Surgery
Background:
- Endoscopic craniosynostosis repair is typically for infants under 6 months.
- Open repair is standard for older infants (≥6 months) due to perceived better outcomes.
- This study investigates endoscopic approaches for older infants.
Purpose of the Study:
- To determine the success rate of endoscopic-assisted craniectomy for sagittal craniosynostosis in infants 6 months and older.
- To identify factors associated with satisfactory outcomes in this age group.
Main Methods:
- Retrospective cohort study of 14 infants (6-9 months) with isolated, nonsyndromic sagittal craniosynostosis.
- Primary outcome: satisfactory result (cephalic index ≥70).
- Secondary outcomes: change in cephalic index, intracranial pressure (ICP), adverse events.
Main Results:
- 85.7% of patients achieved satisfactory results (CI ≥70).
- Younger age at surgery was associated with better outcomes (P=.005).
- ICP significantly decreased post-surgery (P=.012); no adverse events reported.
Conclusions:
- Endoscopic-assisted release is effective for sagittal craniosynostosis in 6-9 month olds.
- Outcomes are not significantly impacted by head growth velocity or bone thickness.
- Consider endoscopic release for this age group at experienced centers.
Background:
Endoscopic approaches to sagittal craniosynostosis are typically used in children <6 months because of more predictable outcomes with postoperative helmet therapy. For children presenting at 6 months or older, surgeons usually opt for open repair for more predictable correction.
Purpose:
The study's purpose was to estimate the incidence of satisfactory results and identify associated factors for children 6 months and older undergoing endoscopic-assisted craniectomy for sagittal craniosynostosis.
Study Design, Setting, Sample:
This retrospective cohort study included children who underwent endoscopic-assisted craniectomies for isolated, nonsyndromic sagittal craniosynostosis between 2018 and 2025 at UT Health San Antonio and El Paso Children's Hospital. Subjects who underwent a cranial vault reconstruction or prior surgery were excluded.
Predictor Variables:
Included age at surgery, preoperative cephalic index (CI), and time from surgery.
Main Outcome Variables:
The primary outcome was achieving a satisfactory result, as defined by the surgery team for a CI measurement ≥70. Postoperative CI was categorized as excellent (≥75), good (70 to <75), or poor (<70). Secondary outcomes included absolute change in CI, changes in intracranial pressure (ICP), and adverse events.
Covariates:
Included sex, head circumference, and craniectomy size.
Analysis:
Bivariate analysis assessed associations between the satisfactory outcome, absolute change in CI, and the predictor variables. A paired sample t-test was used to compare changes in CI. Simple linear regression and analysis of variance were used to evaluate the relationship between age at surgery and CI changes.
Results:
The sample included 14 subjects with a mean age of 7.56 (±1.1) months; 11 (78.6%) were male. Median follow-up was 15 months (interquartile range, 11 to 23). Satisfactory results were achieved in 12 children (85.7%). Age at surgery was negatively associated with satisfactory results (P = .005). No adverse events occurred. Among 7 (50%) children with available intraoperative ICP measurements, ICP decreased significantly following suture release (P = .012).
Conclusions And Relevance:
Endoscope-assisted release for sagittal craniosynostosis in children aged 6 to 9 months yields satisfactory results in most cases. Head growth velocity and bone thickness at this age did not appear to significantly impact outcomes. Endoscopic-assisted release should be considered for children in this age group presenting at centers with experienced craniofacial and orthotic teams.
