School-Aged Anthropometric Outcomes After Endoscopic or Open Repair of Metopic Synostosis

Abstract

BACKGROUND AND OBJECTIVES: Metopic craniosynostosis can be treated by fronto-orbital advancement or endoscopic strip craniectomy with postoperative helmeting. Infants younger than 6 months of age are eligible for the endoscopic repair. One-year postoperative anthropometric outcomes have been shown to be equivalent, with significantly less morbidity after endoscopic treatment. The authors hypothesized that both repairs would yield equivalent anthropometric outcomes at 5-years postoperative.METHODS: This study was a retrospective chart review of 31 consecutive nonsyndromic patients with isolated metopic craniosynostosis treated with either endoscopic or open correction. The primary anthropometric outcomes were frontal width, interfrontal divergence angle, the Whitaker classification, and the presence of lateral frontal retrusion. Peri-operative variables included estimated blood loss, rates of blood transfusion, length of stay, and operating time.RESULTS: There was a significantly lower rate of lateral frontal retrusion in the endoscopic group. No statistically significant differences were found in the other 3 anthropometric outcomes at 5-years postoperative. The endoscopic group was younger at the time of surgery and had improved peri-operative outcomes related to operating time, hospital stay and blood loss. Both groups had low complication and reoperation rates. CONCLUSIONS:In our cohort of school-aged children with isolated metopic craniosynostosis, patients who underwent endoscopic repair had superior or equivalent outcomes on all 4 primary anthropometric measures compared with those who underwent open repair. Endoscopic repair was associated with significantly faster recovery and decreased morbidity. Endoscopic repair should be considered in patients diagnosed with metopic craniosynostosis before 6 months of age.WHAT'S KNOWN ON THIS SUBJECT: Traditionally, metopic craniosynostosis was treated with open fronto-orbital advancement. More recently, minimally invasive endoscopic strip craniectomy has gained favor and has been shown to have equivalent anthropometric outcomes, with decreased morbidity at 1 year. School-aged outcomes are unknown.WHAT THIS STUDY ADDS: When evaluated at school age, endoscopic correction of metopic craniosynostosis leads to equivalent anthropometric outcomes as open repair with significantly decreased morbidity. Early referral to a craniofacial center by the pediatrician is crucial in maintaining eligibility for the endoscopic repair.

Superior Long-term Appearance of Strip Craniectomy Compared with Cranial Vault Reconstruction in Metopic Craniosynostosis

“…Though anthropometric measurements have been used to objectively characterize skull morphology, they remain insufficient to comprehensively assess aesthetic outcomes. 16,17,19,22 No described measurement captures adverse aesthetic outcomes that are commonly observed following craniosynostosis repair, such as irregularities of the forehead contour. Since aesthetic and social concerns are among the primary indications for surgery, this represents a meaningful deficiency in the literature.…”

Comparison of Head Shape Outcomes in Metopic Synostosis Using Limited Strip Craniectomy and Open Vault Reconstruction Techniques

“…Overall, these data trend toward convergence of results in the 2 techniques over time. The convergence of the 2 techniques is corroborated by Ha et al (2020), which found no difference 5 years postoperatively in frontal width, interfrontal divergence angle, and Whitaker classification between endoscopic and open technique.…”

“…There is no widely used, agreed upon quantitative method for evaluation of MCS, so this study chose to evaluate forehead changes with both 3D (Figure 4) and two-dimensional (2D; Figure 2 angle (Kellogg et al, 2012;Anolik et al, 2016;Glener et al, 2017;Ha et al, 2020), anthropometrics/cephalometrics (Mendonca et al, 2013;Ha et al, 2020), interfrontal-interparietal ratio (Ruiz-Correa et al, 2008), 3D contour (Cho et al, 2016), and series of 2D slices (Ruiz-Correa et al, 2008;Weathers et al, 2014). Three-dimensional surface images provided by stereophotogrammetric photography allow for full representation of the entire contour of the head without ionizing radiation (Shah et al, 2011;Engel et al, 2012).…”

“…Open techniques vary markedly between surgeons, for example, the degree of overcorrection employed (Metzler et al, 2014; Bennett et al, 2018). More recently, limited incision strip craniectomy (LISC) followed by helmet orthotic treatment, pioneered by Barone and Jimenez, has been promoted for its shorter operative time, lower blood loss, lower cost, and equivalent outcomes (Jimenez and Barone, 1998; Barone and Jimenez, 1999; Chan et al, 2013; Goyal et al, 2018; Jimenez et al, 2018; Ha et al, 2020).…”

“…Others might be negatively influenced by the length of time LISC takes to achieve normalization of shape compared to OCVR, or the need to wear an orthotic helmet (Kung et al, 2016; Mann et al, 2017; Jimenez et al, 2018). Proponents of LISC may prefer the relative simplicity of the procedure; with lower blood loss, shorter operative times, less scarring, and their belief that long-term shape outcomes are equivalent or even superior (Shah et al, 2011; Gociman et al, 2013; Le et al, 2014; Nguyen et al, 2015; Han et al, 2016; Goyal et al, 2018; Jimenez et al, 2018; Ha et al, 2020). Subjective assessments of outcomes have not led to a gold standard method of measuring MCS severity and treatment (Paige et al, 2003; Jaskolka, 2017; Braun et al, 2018).…”