Spring-mediated cranioplasty versus endoscopic strip craniectomy for sagittal craniosynostosis

Abstract

OBJECTIVE Endoscopic strip craniectomy (ESC) and spring-mediated cranioplasty (SMC) are two minimally invasive techniques for treating sagittal craniosynostosis in early infancy. Data comparing the perioperative outcomes of these two techniques are sparse. Here, the authors hypothesized that outcomes would be similar between patients undergoing SMC and those undergoing ESC and conducted a study using the multicenter Pediatric Craniofacial Surgery Perioperative Registry (PCSPR). METHODS The PCSPR was queried for infants under the age of 6 months who had undergone SMC or ESC for sagittal synostosis. SMC patients were propensity score matched 1:2 with ESC patients on age and weight. Primary outcomes were transfusion-free hospital course, intensive care unit (ICU) admission, ICU length of stay (LOS), and hospital length of stay (HLOS). The authors also obtained data points regarding spring removal. Comparisons of outcomes between matched groups were performed with multivariable regression models. RESULTS The query returned data from 676 infants who had undergone procedures from June 2012 through September 2019, comprising 580 ESC infants from 32 centers and 96 SMC infants from 5 centers. Ninety-six SMC patients were matched to 192 ESC patients. There was no difference in transfusion-free hospital course between the two groups (adjusted odds ratio [aOR] 0.78, 95% CI 0.45–1.35). SMC patients were more likely to be admitted to the ICU (aOR 7.50, 95% CI 3.75–14.99) and had longer ICU LOSs (incident rate ratio [IRR] 1.42, 95% CI 1.37–1.48) and HLOSs (IRR 1.28, 95% CI 1.17–1.39). CONCLUSIONS In this multicenter study of ESC and SMC, the authors found similar transfusion-free hospital courses; however, SMC infants had longer ICU LOSs and HLOSs. A trial comparing longer-term outcomes in SMC versus ESC would further define the roles of these two approaches in the management of sagittal craniosynostosis.

Intracranial Pressure Patterns in Children with Sagittal Craniosynostosis

“…Multiple factors must be considered when weighing early intervention with strip craniectomy and spring-mediated cranioplasty or molding orthosis versus whole-vault cranioplasty for children with sagittal craniosynostosis. 36–40 This study using OCT technology concluded that elevated ICP appears to be very uncommon when minimally invasive surgical correction is undertaken earlier than 6 months of age, whereas children older than 6 months have a significantly higher likelihood of elevated ICP. We believe that this adds to the potential advantages of earlier intervention in patients who present in the first 6 months of life, acknowledging the importance of further research to clarify the relationship between ICP and neurocognitive outcomes.…”

Choosing a Multidisciplinary Cleft and Craniofacial Team: Medical, Surgical, and Social Considerations

“…8 Although the election for endoscopic versus open procedures is certainly a multifaceted one, emerging literature highlights the favorable peri- and postoperative profile of endoscopic approaches for several craniofacial operations, including reduced blood loss, 13 decreased operative time, 13 and shorter ICU length of stay. 14,15 Additionally, academic institutions often have multiple clinicians in any given specialty from which knowledge bases can be tapped to maximize patient care. It is unreasonable to expect a team's craniofacial surgeon to suggest robust solutions to a patient's otologic concerns compared to those offered by the team's pediatric otolaryngologist, and vice versa.…”