Endoscopic Versus Open Cranial Reconstruction Surgery for Anterior Craniosynostosis: Experience from South-East Asia

Abstract

Introduction and objective: Craniosynostosis is a pathological condition resulting from premature closure of cranial sutures. Open cranial vault reconstruction has been the standard of care for isolated non-syndromic craniosynostosis. The current centre introduced the endoscopic craniosynostosis surgery in 2015. The aim of the study is to compare safety outcomes of endoscopic versus open surgery in craniosynostosis within the context of a developing healthcare system, with a focus on anterior synostosis. Methods: This was a retrospective study of all patients undergoing surgery for anterior craniosynostosis from 2012 to 2018 at a single institution. Data on age at surgery, demographics, sutures, surgery duration and complications, including follow up information was obtained. We excluded syndromic patients and patients with pan-synostosis. Statistical analysis was undertaken with P value set at <.05. Results: There were totally 40 patients who underwent craniosynostosis surgery. Seventeen patients underwent endoscopic correction, and 23 open procedures. Metopic and coronal suture patients were equally distributed, with an equal sex distribution. The mean age at surgery in the endoscopic group was 3.7 months (3-5) and higher at 11.5 months (8-18) in the open group ( P < .05). The duration of surgery, blood loss and overall length of hospital stay were significantly reduced in the endoscopic group ( P < .05). In the endoscopic cohort, patients with metopic synostosis obtained complete correction, while patients with unicoronal synostosis had minor residual frontal asymmetry. There were no immediate post-operative complications in the endoscopic group, but the open surgery cohort had minor dural tears in 6 patients. Conclusion: The endoscopic technique has a better safety profile than open surgery for craniosynostosis and results in a complete correction in patients with metopic and bicoronal craniosynostosis.

Outcomes of endoscopic treatment for early correction of craniosynostosis in children: A 26-year single center experience

“…2A and 2B). These results are consistent with other series and systematic reviews [13,21,[27][28][29][30][31][32][33][34][35]. Jiménez and Barone [20] and Dalle Ore et al…”

“…This data is consistent with other studies that report transfusion requirements between 4% and 10% for EAS [20,34,[47][48][49][50]. In the study by Mendonca et al, none of their 17 patients with EAS required a transfusion [21]. On the contrary, Melin et al [30], Honeycutt et al [44],…”

“…2C). This nding is consistent in all series and systematic reviews [13,20,35,36,50,21,[28][29][30][31][32][33][34]. A multicenter study that included 1382 children under 12 months reported a mean of 70 minutes in the EAS and 115 minutes in the OS [51].…”

“…Most studies agree that the ideal time to perform early EAS is the rst 3 month [21][22][23], since the skull is soft, with a thickness of < 2 mm in the frontal and parietal bones [24,25] facilitating strip craniectomies. In our cohort, the average age for patients with EAS was 4 months, with a range of 15 days to 6 months.…”

“…We consider this age limit because at 6 months the frontal and parietal bones are approximately 2.5-3 mm thick [24,25]. In addition, within the rst 6 months there is a higher rate of cranial growth, with enormous bone distensibility, which allows the brain to act as an internal distractor, driving expansion of the skull [21]. Although some centers perform minimally invasive craniosynostosis surgeries in children older than 6 to 11 months [20,26,27], for now at our institution we restrict the use of EAS to children ≤ 6 months.…”