Isolated Sagittal Craniosynostosis and Open or Endoscopic Cranial Vault Remodeling: An Evaluation of Developmental Outcomes

Abstract

Background: Craniosynostosis, a condition involving the premature fusion of cranial sutures, can impair brain development and potentially lead to developmental delays. This study compares open cranial vault remodeling versus endoscopic strip craniectomy treatment for isolated sagittal craniosynostosis, primarily focusing on development outcomes. Methods: A retrospective cohort study was conducted at a tertiary pediatric surgery center, involving all 45 patients treated surgically for isolated sagittal craniosynostosis from 2013 to 2024. Patients were categorized into 2 groups based on surgical intervention: open cranial vault remodeling (n=17) and endoscopic strip craniectomy (n=28). Data collected included patient demographics, intraoperative specifics, and postoperative outcomes. Developmental outcomes were assessed using postoperative progress notes. Results: Of the 45 patients, those undergoing open surgery were older (10.7 mo and 9.4 kg versus 3.3 mo and 6.4 kg, P<0.001) and experienced higher use of intraoperative drains (65% versus 0%, P<0.001), more prolonged procedures (189 versus 58 min, P<0.001), more significant blood loss (102 versus 62 mL, P=0.009), longer stays (3.3 versus 2.6 d, P=0.011), and higher opioid prescription rates (82% versus 43%, P=0.013) compared to the endoscopic group. Within 12 months postoperatively, social delays were more common in the open group (19 versus 0%, P=0.049), and, postoperatively in general, cognitive delays were more common in the open group (31% versus 4%, P=0.023) when compared to the endoscopic group. Conclusions: Endoscopic cranial vault remodeling produces preferentially better hemodynamic, postoperative, and hospital stay outcomes. Although inferences into long-term developmental delay outcomes were limited due to sample size, a preferential benefit toward endoscopic intervention may exist.