Safety Outcomes in Endoscopic Versus Open Repair of Metopic Craniosynostosis

Braun, Tara L.; Eisemann, Bradley S.; Olorunnipa, Olushola; Buchanan, Edward P.; Monson, Laura A.

doi:10.1097/scs.0000000000004299

Cited by 31 publications

(27 citation statements)

References 41 publications

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“…Most of the sutures involved were the anterior sutures (metopic and coronal). The mean age at surgery in the endoscopic group was 3.7 months (3-5) and higher at 11.5 months (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(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).…”

Section: Resultsmentioning

confidence: 91%

“…[7][8][9][10] Minimally invasive techniques are gaining popularity due to their short incisions, reduced morbidity, quick recovery and relative safety. [7][8][9][10] In developing countries, internet penetration is increasing, along with increased acceptance of new technologies. Parents are using FACE 1 (2) the internet to research latest technical advances and are keen to seek treatment early.…”

Section: Introductionmentioning

confidence: 99%

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

Mendonca

Gopal²,

Gujjalanavar³

et al. 2020

FACE

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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.

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Section: Resultsmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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

Mendonca

Gopal²,

Gujjalanavar³

et al. 2020

FACE

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“…The clinical advantages of endoscopic treatment of craniosynostosis over open CVR have been well documented and include decreased operative blood loss and transfusion requirements, as well as shorter operative times and LOS. 1,6,10,13,14,18,21,31,39 An increasing body of literature from our institution and others has demonstrated promising outcomes in cranial morphology after EAC FIG. 3.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic techniques combined with postoperative molding helmet therapy have shown promising postoperative outcomes, with the benefits of reductions of the following: blood loss, transfusion requirement, operative time, and duration of hospitalization. 1,6,10,13,14,18,21,31,39 The endoscopic approach is becoming an increasingly appealing alternative to traditional open reconstructions. Concurrently, there has been increasing interest in the discrepancy in the costs of these two significantly different surgical approaches to the same cranial malformation.…”

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confidence: 99%

Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques

Zubovic

Lapidus

Skolnick

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEManagement of craniosynostosis at an early age is important for mitigating the risk of abnormal cranial development, but treatment can result in significant expenses. Previous research has shown that endoscope-assisted craniectomy (EAC) is less costly than open cranial vault remodeling (CVR) for patients with sagittal synostosis. The aim of this study was to strengthen the existing body of healthcare cost research by elucidating the charges associated with open and endoscopic treatment for patients with nonsagittal synostosis.METHODSThe authors performed a retrospective analysis of data obtained in 41 patients who underwent open CVR and 38 who underwent EAC with postoperative helmet therapy for nonsagittal, single-suture craniosynostosis (metopic, coronal, and lambdoid) between 2008 and 2018. All patients were < 1 year of age at the time of surgery and had a minimum 1 year of follow-up. Inpatient charges, physician fees, helmet charges, and outpatient clinic visits in the 1st year were analyzed.RESULTSThe mean ages of the children treated with EAC and open CVR were 3.5 months and 8.7 months, respectively. Patients undergoing EAC with postoperative helmet therapy required more outpatient clinic visits in the 1st year than patients undergoing CVR (4 vs 2; p < 0.001). Overall, 13% of patients in the EAC group required 1 helmet, 30% required 2 helmets, 40% required 3 helmets, and 13% required 4 or more helmets; the mean total helmeting charges were $10,072. The total charges of treatment, including inpatient charges, physician fees, outpatient clinic visit costs, and helmet charges, were significantly lower for the EAC group than they were for the open CVR group ($50,840 vs $95,588; p < 0.001).CONCLUSIONSDespite the additional charges for postoperative helmet therapy and the more frequent outpatient visits, EAC is significantly less expensive than open CVR for patients with metopic, coronal, and lambdoid craniosynostosis. In conjunction with the existing literature on clinical outcomes and perioperative resource utilization, these data support EAC as a cost-minimizing treatment for eligible patients with nonsagittal synostosis.

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“…In a recent report Challenges comprised: the small scalp incision, long distance from incision to nasofrontal suture, presence of venous perforators from the sagittal sinus, and the narrow osteotomy corridor (5 mm). Most authors shared these observations and point of view concerning early cosmetic results [29][30][31][32][33][34][35]. Others analyzed their long-term results using a microscopic minimally invasive approach and concluded that it was not appropriate for trigonocephaly, and therefore stopped using this technique in these patients [31].…”

Section: Endoscopic and Microscopic Minimally Invasive Approachesmentioning

confidence: 95%

Recent advances in trigonocephaly

2019

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Introduction. The aim of this review was to report on recent advances in trigonocephaly since the last report on craniosynostosis published in 2006. Material and methods. The review was conducted in accordance with the PRISMA guidelines. Research focused on four main topics: epidemiology, neurodevelopmental disorders, genetics and surgical techniques. Results. Forty reports were included. The prevalence of trigonocephaly increased during the last two decades both in Europe and in the United States, but no clear contributing factors have yet been identified. Neurodevelopmental disorders are frequent in syndromic trigonocephaly and not particularly rare in non-syndromic cases (up to 34%). Developmental retardation (speech, motor or global) was almost always present in children exposed to valproic acid. Chromosomal abnormalities described in metopic synostosis comprised deletion of chromosome 11q24, deletion or trisomy of 9p and deletion of 7p, deletions of 3q, 13q, 12pter, 22q11, and duplication of 15q25. SMAD6 mutations should be systematically screened for in familial cases. Recent advances in surgical techniques have mainly concerned endoscopic-assisted procedures, as they significantly reduce perioperative morbidity. Conclusions. Neurosurgeons, maxillofacial and plastic surgeons will be increasingly concerned with trigonocephaly because of the increase in prevalence observed over the last two decades. Cytogenetic alterations are probably underestimated in this craniosynostosis, considering the high rate of neurodevelopmental retardation compared to other single-suture synostoses. Genetic counseling is therefore more and more effective in this pathology. An objective method to evaluate the cosmetic results of both endoscopic and open surgeries is necessary, as some under-corrections have been reported with minimally invasive surgery.

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Safety Outcomes in Endoscopic Versus Open Repair of Metopic Craniosynostosis

Abstract: In our patient population, endoscopic surgery for metopic craniosynostosis had an improved safety profile versus open surgery based on reduced procedure length, estimated blood loss, volume of blood transfusion, and length of stay in the ICU and hospital.

Cited by 31 publications

References 41 publications

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

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

Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques

Recent advances in trigonocephaly

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