Skip to main content
SpringerLink
Log in

Endoscopic versus open approach in craniosynostosis repair: a systematic review and meta-analysis of perioperative outcomes

  • Review Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Introduction

Surgery for craniosynostosis remains a crucial element in successful management. Intervention by both endoscopic and open approaches has been proven effective. Given the differences in timing and indications for these procedures, differences in perioperative outcomes have yet to be thoroughly compared between the two approaches. The aim of the systematic review and meta-analysis was to assess the available evidence of perioperative outcomes between the two approaches in order to better influence the management paradigm of craniosynostosis.

Methods

We followed recommended PRISMA guidelines for systematic reviews. Seven electronic databases were searched to identify all potentially relevant studies published from inception to February 2018 which were then screened against a set of selection criteria. Data were extracted and analyzed using meta-analysis of proportions.

Results

Twelve studies satisfied all the selection criteria to be included, which described a pooled cohort involving 2064 craniosynostosis patients, with 965 (47%) and 1099 (53%) patients undergoing surgery by endoscopic and open approaches respectively. When compared to the open approach, it was found that the endoscopic approach conferred statistically significant reductions in blood loss (MD = 162.4 mL), operative time (MD = 112.38 min), length of stay (MD = 2.56 days), and rates of perioperative complications (OR = 0.58), reoperation (OR = 0.37) and transfusion (OR = 0.09), where all p < 0.001.

Conclusion

Both endoscopic and open approaches for the surgical management of craniosynostosis are viable considerations. The endoscopic approach confers a significant reduction in operative and postoperative morbidity when compared to the open approach. Given that specific indications for either approach should be considered when managing a patient, the difference in perioperative outcomes remain an important element of this paradigm. Future studies will validate the findings of this study and consider long-term outcomes, which will all contribute to rigor of craniosynostosis management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

GRADE:

Grading of Recommendations Assessment

Development and Evaluation

NOS:

Newcastle-Ottawa Scale

OR:

Odds ratio

RR:

Relative risk

MD:

Mean difference

SMD:

Standardized mean difference

References

  1. Abbott MM, Rogers GF, Proctor MR, Busa K, Meara JG (2012) Cost of treating sagittal synostosis in the first year of life. J Craniofac Surg 23:88–93

    Article  PubMed  Google Scholar 

  2. Arts S, Delye H, van Lindert EJ (2018) Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures. J Neurosurg Pediatr 21:112–118

    Article  PubMed  Google Scholar 

  3. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S et al (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490

    Article  PubMed  Google Scholar 

  4. Bonfield CM, Sharma J, Cochrane DD, Singhal A, Steinbok P (2016) Minimizing blood transfusions in the surgical correction of craniosynostosis: a 10-year single-center experience. Childs Nerv Syst 32:143–151

    Article  PubMed  Google Scholar 

  5. Chan JWH, Stewart CL, Stalder MW, St Hilaire H, McBride L, Moses MH (2013) Endoscope-assisted versus open repair of craniosynostosis: a comparison of perioperative cost and risk. J Craniofac Surg 24:170–174

    Article  PubMed  Google Scholar 

  6. Cook DA, Reed DA (2015) Appraising the quality of medical education research methods: the Medical Education Research Study Quality Instrument and the Newcastle-Ottawa Scale-Education. Acad Med 90:1067–1076

    Article  PubMed  Google Scholar 

  7. Farber SJ, Nguyen DC, Skolnick GB (2017): Anthropometric outcome measures in patients with metopic craniosynostosis. Journal of: Available: https://journals.lww.com/jcraniofacialsurgery/Abstract/2017/05000/Anthropometric_Outcome_Measures_in_Patients_With.32.aspx

  8. Garber ST, Karsy M, Kestle JRW, Siddiqi F, Spanos SP, Riva-Cambrin J (2017) Comparing outcomes and cost of 3 surgical treatments for sagittal synostosis: a retrospective study including procedure-related cost analysis. Neurosurgery 81:680–687

    PubMed  Google Scholar 

  9. Ghenbot RG, Patel KB, Skolnick GB, Naidoo SD, Smyth MD, Woo AS (2015) Effects of open and endoscopic surgery on skull growth and calvarial vault volumes in sagittal synostosis. J Craniofac Surg 26:161–164

    Article  PubMed  PubMed Central  Google Scholar 

  10. Han RH, Nguyen DC, Bruck BS, Skolnick GB, Yarbrough CK, Naidoo SD, Patel KB, Kane AA, Woo AS, Smyth MD (2016) Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution. J Neurosurg Pediatr 17:361–370

    Article  PubMed  Google Scholar 

  11. Hinojosa J, Esparza J, Muñoz MJ (2007) Endoscopic-assisted osteotomies for the treatment of craniosynostosis. Childs Nerv Syst 23:1421–1430

    Article  PubMed  CAS  Google Scholar 

  12. Jimenez DF, Barone CM (2012) Bilateral endoscopic craniectomies in the treatment of an infant with Apert syndrome. J Neurosurg Pediatr 10:310–314

    Article  PubMed  Google Scholar 

  13. Jimenez DF, Barone CM (1998) Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg 88:77–81

    Article  PubMed  CAS  Google Scholar 

  14. Jimenez DF, Barone CM, Cartwright CC, Baker L (2002) Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy. Pediatrics 110:97–104

    Article  PubMed  Google Scholar 

  15. Jimenez DF, Barone CM, McGee ME, Cartwright CC, Baker CL (2004) Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis. J Neurosurg Pediatr 100:407–417

    Article  Google Scholar 

  16. Keshavarzi S, Hayden MG, Ben-Haim S, Meltzer HS, Cohen SR, Levy ML (2009) Variations of endoscopic and open repair of metopic craniosynostosis. J Craniofac Surg 20:1439–1444

    Article  PubMed  Google Scholar 

  17. Lane LC (1892) Pioneer craniectomy for relief of mental imbecility due to premature sutural closure and microcephalus. JAMA XVIII:49–50

    Article  Google Scholar 

  18. Lannelongue M (1890) De La Craniectomie Dans La Microcephalie. CR Seances Acad Sci 110:1382

    Google Scholar 

  19. Lee HQ, Hutson JM, Wray AC, Lo PA, Chong DK, Holmes AD, Greensmith AL (2012) Analysis of morbidity and mortality in surgical management of craniosynostosis. J Craniofac Surg 23:1256–1261

    Article  PubMed  Google Scholar 

  20. Le M-B, Patel K, Skolnick G, Naidoo S, Smyth M, Kane A et al (2014) Assessing long-term outcomes of open and endoscopic sagittal synostosis reconstruction using three-dimensional photography. J Craniofac Surg 25:573–576

    Article  PubMed  Google Scholar 

  21. Liberati A, Tetzlaff J, Altman DG, Group P 2009 Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Available: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000097, 6, e1000097

  22. Murad G, Clayman M, Seagle MB, White S: Endoscopic-assisted repair of craniosynostosis. Neurosurgical:2005 Available: http://thejns.org/doi/abs/10.3171/foc.2005.19.6.7

  23. Nguyen DC, Patel KB, Skolnick GB, Naidoo SD, Huang AH, Smyth MD, Woo AS (2015) Are endoscopic and open treatments of metopic synostosis equivalent in treating trigonocephaly and hypotelorism? J Craniofac Surg 26:129–134

    Article  PubMed  Google Scholar 

  24. Panchal J, Marsh JL, Park TS, Kaufman B, Pilgram T, Huang SH (1999) Sagittal craniosynostosis outcome assessment for two methods and timings of intervention. Plast Reconstr Surg 103:1574–1584

    Article  PubMed  CAS  Google Scholar 

  25. Seymour-Dempsey K, Baumgartner JE, Teichgraeber JF, Xia JJ, Waller AL, Gateno J (2002) Molding helmet therapy in the management of sagittal synostosis. J Craniofac Surg 13:631–635

    Article  PubMed  Google Scholar 

  26. Shah MN, Kane AA, Petersen JD, Woo AS, Naidoo SD, Smyth MD (2011) Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children’s Hospital experience. J Neurosurg Pediatr 8:165–170

    Article  PubMed  Google Scholar 

  27. Thompson DR, Zurakowski D, Haberkern CM, Stricker PA, Meier PM, Bannister C, Benzon H, Binstock W, Bosenberg A, Brzenski A, Budac S, Busso V, Capehart S, Chiao F, Cladis F, Collins M, Cusick J, Dabek R, Dalesio N, Falcon R, Fernandez A, Fernandez P, Fiadjoe J, Gangadharan M, Gentry K, Glover C, Goobie S, Gries H, Griffin A, Groenewald CB, Hajduk J, Hall R, Hansen J, Hetmaniuk M, Hsieh V, Huang H, Ingelmo P, Ivanova I, Jain R, Koh J, Kowalczyk-Derderian C, Kugler J, Labovsky K, Martinez JL, Mujallid R, Muldowney B, Nguyen KP, Nguyen T, Olutuye O, Soneru C, Petersen T, Poteet-Schwartz K, Reddy S, Reid R, Ricketts K, Rubens D, Skitt R, Sohn L, Staudt S, Sung W, Syed T, Szmuk P, Taicher B, Tetreault L, Watts R, Wong K, Young V, Zamora L, Pediatric Craniofacial Collaborative Group (2018) Endoscopic versus open repair for craniosynostosis in infants using propensity score matching to compare outcomes: a multicenter study from the pediatric craniofacial collaborative group. Anesth Analg 126:968–975

    Article  PubMed  Google Scholar 

  28. Tobias JD, Johnson JO, Jimenez DF, Barone CM, McBride DS Jr (2001) Venous air embolism during endoscopic strip craniectomy for repair of craniosynostosis in infants. Anesthesiology 95:340–342

    Article  PubMed  CAS  Google Scholar 

  29. van Nunen DPF, Stubenitsky BM, Woerdeman PA, Han KS, Breugem CC, Mink van der Molen AB et al (2016) Minimally invasive strip craniectomy simplifies anesthesia practice in patients with isolated sagittal synostosis. J Craniofac Surg 27:1985–1990

    Article  PubMed  Google Scholar 

  30. Vogel TW, Woo AS, Kane AA, Patel KB, Naidoo SD, Smyth MD (2014) A comparison of costs associated with endoscope-assisted craniectomy versus open cranial vault repair for infants with sagittal synostosis. J Neurosurg Pediatr 13:324–331

    Article  PubMed  Google Scholar 

  31. Zubovic E, Woo AS, Skolnick GB, Naidoo SD, Smyth MD, Patel KB (2015) Cranial base and posterior cranial vault asymmetry after open and endoscopic repair of isolated lambdoid craniosynostosis. J Craniofac Surg 26:1568–1573

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA

    Anshit Goyal, Victor M. Lu, Yagiz U. Yolcu & Mohamed Elminawy

  2. Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    Anshit Goyal, Yagiz U. Yolcu, Mohamed Elminawy & David J. Daniels

  3. Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia

    Victor M. Lu

Authors
  1. Anshit Goyal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Victor M. Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yagiz U. Yolcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed Elminawy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David J. Daniels
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David J. Daniels.

Ethics declarations

Conflict of interest

No funding sources or conflicts of interest to disclose.

Electronic supplementary material

Supplemental table 1

(DOCX 78.7 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goyal, A., Lu, V.M., Yolcu, Y.U. et al. Endoscopic versus open approach in craniosynostosis repair: a systematic review and meta-analysis of perioperative outcomes. Childs Nerv Syst 34, 1627–1637 (2018). https://doi.org/10.1007/s00381-018-3852-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-018-3852-4

Keywords

Search

Navigation