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Endoscopic Strip Craniectomy Performed Earlier Than Three Months Of Age For Nonsyndromic Craniosynostosis Has Comparable Long-term Outcomes To Later Age Surgery
Robin T. Wu, MD, Brian Sweeney, MD, Olubunmi Ayomikun Farikiye, BS, Sofia Eguizabal, BS, Kevin Yang, MD, Rohit Khosla, MD, FACS, Hermann Peter Lorenz, MD.
Stanford University, Stanford, CA, USA.
Introduction: The aim of this study was to compare perioperative and long-term outcomes in patients treated earlier than the three months of age to those treated after three months of age.
Methods: Non-syndromic craniosynostosis (NSC) patients at a single institution, with >24months follow-up, were retrospectively reviewed, stratified based on age at surgery <3months or between 3-15month.
Results: A total of 120 NSC patients were surgically treated (Average follow-up 4.6
+1.8years). Thirty patients underwent endoscopic strip craniectomy at <3 months of age (mean 2.18
+0.51months, 77% male); all underwent post-operative helmeting. Of these, 73% had sagittal, 13% metopic, and 13% unicoronal synostosis. Ninety patients underwent surgical correction between 3-15month (mean 7.18
+2.9months, 63% male). Of these, 58% were diagnosed with sagittal, 21% metopic, and 8% unicoronal. Endoscopic strip craniectomy was performed in 16.7% and open calvarial remodeling was performed in 83.3%. Patients who had earlier surgery had significantly less blood loss per kg body weight (8.52mL/kg vs 21.1
+13.2mL/kg) and less transfusions (7.76
+9.0 mL/kg vs 16.79
+ 2.9 mL/kg; p < 0.001). No differences in intraoperative transexamic acid, post-operative transfusion, or changes in hemoglobin were found. When comparing patients treated with endoscopic surgery only, between age groups, there was no differences in blood loss or transfusion. There was no difference in helmet duration, reoperation rate, developmental delay, anxiety, psychiatric diagnoses, or ophthalmologic diagnoses between patients treated <3months and those 3-15months.
Conclusion:Patients younger than three months of age can safely undergo early endoscopic strip craniectomy with equivalent perioperative morbidity and comparable long-term outcomes.
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