Endoscopic surgery for craniosynostosis: A systematic review and single-arm meta analysis

Porto Junior, Silvio; Meira, Davi Amorim; da Cunha, Beatriz Lopes Bernardo; Fontes, Jefferson; Pustilnik, Hugo Nunes; da Silva da Paz, Matheus Gomes; Araujo, Taiane Brito; Alcântara, Tancredo; Dourado, Jules Carlos; de Avellar, Leonardo Miranda

doi:10.1016/j.clineuro.2024.108296

Clinical Neurology and Neurosurgery

2024

DOI: 10.1016/j.clineuro.2024.108296

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Endoscopic surgery for craniosynostosis: A systematic review and single-arm meta analysis

Silvio Porto Junior,

Davi Amorim Meira,

Beatriz Lopes Bernardo da Cunha

et al.

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Cited by 3 publications

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Efficacy of Molding Helmet Therapy following Suturectomy for Craniosynostosis: A Single-center, Retrospective Analysis in Japan

Kurimoto,

Nawashiro,

Nagakura

et al. 2024

Journal of Craniofacial Surgery

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Craniosynostosis limits normal cranial growth, significantly affecting the growth and development of children. This increase in intracranial pressure results in significant cosmetic and functional losses. This study investigated the efficacy of combining molding helmets with suturectomy for craniosynostosis. Patients who underwent suturectomy and molding helmet therapy for craniosynostosis at a single institution between 2017 and 2024 were included. Changes in cephalic index (CI) and cranial vault asymmetry index (CVAI) were analyzed. A total of 14 patients (12 males, 2 females) were included, with a median age of 4.5 months (2–6 mo). The affected sutures were as follows: sagittal (n=8), bilateral coronal (n=4), unilateral coronal (n=1), and lambdoid (n=1) sutures. The median duration of postoperative molding helmet therapy was 44.5 weeks. For the sagittal suture group, the median preoperative CI, median postoperative CI, and rate of change were 72.0 (68.3–85.8), 77.0 (72.1–86.4), and 0.0646, respectively. For the bilateral coronal suture group, measurements for the same parameters were 104.0 (99.3–110.0), 92.5 (89.1–94.5), and 0.1114, respectively. For the unilateral coronal group, the measured parameters were 89.0 (87.7–91.2), 84.0 (81.2–87.1), and 0.059, respectively. Although all suture types showed improvement in cranial shape, with sagittal synostosis showing the most significant change, our findings did not support the added benefit of molding helmet therapy. Overall, the study suggests that suturectomy is a crucial first step in craniosynostosis treatment, leading to improvements in cranial morphology and growth.

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Efficacy of Molding Helmet Therapy following Suturectomy for Craniosynostosis: A Single-center, Retrospective Analysis in Japan

Kurimoto,

Nawashiro,

Nagakura

et al. 2024

Journal of Craniofacial Surgery

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Contralateral Coronal-Lambdoid Craniosynostosis Treated with Distraction Osteogenesis and Spring-Mediated Cranioplasty

Palmer,

Gomez,

Elkhill

et al. 2024

FACE

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Introduction: Treatment of multi-sutural craniosynostosis presents unique challenges and requires a patient specific approach. Patients with contralateral multi-suture craniosynostosis are particularly challenging as the surgical technique utilized must induce opposing forces of expansion. When patients present early in life, early dynamic expansion may be preferable to open approaches. Herein we report a 2-stage technique to treat contralateral right unicoronal and left lambdoid synostosis with simultaneous distraction osteogenesis and spring-mediated cranioplasty. Methods: A 3-month-old male presented to our clinic for concern for head asymmetry. A CT scan confirmed right coronal and left lambdoid craniosynostosis. Preoperative and postoperative head CT and 3D photogrammetry were used to compute the Head Shape Anomaly index (HSA) and difference in head volume from a personalized normative reference for shape and volume. Results: The surgery lasted 163 minutes, and the patient received a 168 mL blood transfusion. The patient was discharged after 3 days. Two springs were placed following a 1 cm strip craniectomy of the lambdoid suture, and a 40 mm uniplane cranial distractor was placed after a right fronto-orbital osteotomy. Devices were removed following activation and consolidation phases. There were no major complications. Postoperative 3D head CT showed correction of left lambdoid and right coronal craniosynostosis with improved plagiocephaly. The patient’s postoperative HSA Index improved from 4.39 pre-operatively to 2.85 at 145 days post-operatively. In addition, the difference in intracranial volume from the personalized normative reference improved from -87.35 mL pre-operatively to 1.65 mL post-operatively. Conclusion: This early dynamic expansion technique provided improved safety outcomes including decreased operative time, transfusion requirement, and hospital stay when compared to other techniques for multi-suture correction such as cranial vault reconstruction. This technique also produced desired results in shape correction and correction of volumetric anomalies. This illustrates the importance of innovation to develop patient specific surgical designs that maximize safety and morphologic outcomes.

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Comparison of Surgical Techniques in Managing Craniosynostosis: Systematic Review and Bayesian Network Meta-Analysis

Putra,

Amirsyah,

Budiman

et al. 2024

Surgeries

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Open total cranial vault reconstruction (CVR) is the common procedure in managing craniosynostosis, yet more techniques have been introduced as alternatives, namely endoscopic suturectomy (ES), endoscopy-assisted craniectomy (EC), spring-assisted surgery (SAS), strip craniectomy with helmet (SC), Pi craniectomy (PiC), Pi plasty (PiP), and Renier’s “H” technique (RH). The aim of this study was to compare the effectiveness of craniosynostosis surgeries in improving the cephalic index of the patients. Studies published until 7 March 2024 reporting CVR, ES, SAS, SC, RH, and PiP as definitive craniosynostosis management with the cephalic index as the outcome were included. Bayesian network meta-analysis and pair-wise meta-analysis were performed using a random-effects model based on standardized mean difference (SMD) and 95% confidence interval (CI). Nine studies published in 2008–2024 recruiting a total of 464 craniosynostosis patients (age: 18–61 months) were included in this meta-analysis. EC (SMD = 0.23 [95%CI: −5.47 to 5.63]; p = 0.935), PiP (SMD = −0.07 [95%CI: −9.27 to 8.79]; p = 0.988), ES (SMD = −0.59 [95%CI: −6.07 to 4.94]; p = 0.834), PiC (SMD = −1.16 [95%CI: −8.89 to 6.35]; p = 0.765), RH (SMD = −0.96 [95%CI: −6.62 to 4.53]; p = 0.736), SAS (SMD = −0.86 [95%CI: −8.25 to 6.18]; p = 0.815), and SC (SMD = −1.79 [95%CI: −9.05 to 5.28]; p = 0.624) were found to be as effective as CVR in improving the cephalic index. Network meta-analysis suggests that PiP is the most effective among these techniques (rank 1 probability = 0.273). According to the rank probabilities of our model the order of techniques from the most to the least effective is as follows: EC > CVR > PiP > ES > SAS > RH > PiC > SC.

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Endoscopic surgery for craniosynostosis: A systematic review and single-arm meta analysis

Cited by 3 publications

References 42 publications

Efficacy of Molding Helmet Therapy following Suturectomy for Craniosynostosis: A Single-center, Retrospective Analysis in Japan

Efficacy of Molding Helmet Therapy following Suturectomy for Craniosynostosis: A Single-center, Retrospective Analysis in Japan

Contralateral Coronal-Lambdoid Craniosynostosis Treated with Distraction Osteogenesis and Spring-Mediated Cranioplasty

Comparison of Surgical Techniques in Managing Craniosynostosis: Systematic Review and Bayesian Network Meta-Analysis

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