Dabbagh Ohadi Mohammad Amin, Maroufi Seyed Farzad, Talebi Kahdouei Mohammadsadegh, Tayebi Meybodi Keyvan, Mirashrafhi Fatemeh, Nejat Farideh, Zeraati Hojjat, Habibi Zohreh
1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran.
2Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran.
Neurosurg Focus. 2025 Jan 1;58(1):E5. doi: 10.3171/2024.10.FOCUS24587.
This study reports the authors' experience with surgical interventions for nonsyndromic craniosynostosis. They assessed open surgery and minimally invasive endoscopic suturectomy in terms of periprocedural outcomes and related risk factors for postoperative complications and reoperation. This study aimed to provide insights toward surgical approach decisions and lay the groundwork for future prospective studies in this field.
In this retrospective cohort study, the medical records of all patients with nonsyndromic craniosynostosis who underwent primary surgery at the authors' center from 2014 to 2024 were analyzed. The authors assessed open surgery and endoscopic suturectomy based on anesthesia time, length of hospitalization, hematological parameters, postoperative blood transfusion volume, and changes in head circumference percentile (HCP). A subgroup analysis was conducted for patients younger than 6 months across different types of craniosynostosis. Further investigation was conducted to identify potential risk factors for postoperative complications and reoperation.
A total of 633 pediatric patients treated for nonsyndromic craniosynostosis were included in this study (281 with endoscopic suturectomy, 352 with open surgery). These data indicated a growing trend for endoscopic procedures. The authors' center began performing endoscopic surgery in 2014, and by 2024, 75% of craniosynostosis patients underwent this procedure (p < 0.001). Patients in the endoscopic group experienced shorter anesthesia times (p < 0.001), reduced lengths of hospitalization (p < 0.001), and lower blood transfusion volumes (p < 0.001) compared with those in the open surgery group; however, blood transfusion volume differences were not significant in the subgroup analysis. The subgroup analysis revealed comparable HCP changes in sagittal (p = 0.4) and coronal (p = 0.85) craniosynostosis. In comparison, greater changes were noted after open surgery in cases of metopic (p = 0.03) and multisuture (p = 0.04) craniosynostosis. The rates of postoperative complications (endoscopic 6.4% and open 4.5%) and reoperation (endoscopic 4.6% and open 2.8%) were comparable between the two groups. In univariate analysis, higher weight (OR 1.07, p < 0.05) was identified as the only risk factor for postoperative complications, which can be attributed to delayed surgical intervention. Coronal (OR 8.38, p < 0.05) and multisuture (OR 23.66, p < 0.01) craniosynostoses were associated with higher reoperation rates, while adding barrel stave osteotomies was linked to a lower reoperation rate (OR 0.22, p < 0.05).
Endoscopic suturectomy is associated with acceptable periprocedural outcomes compared with open surgery, with comparable rates of complications and reoperation. These findings are supported by the subgroup analysis. However, further studies focusing on craniometric outcomes are needed, as surgical procedures have shown variable results across different types of craniosynostosis.
本研究报告了作者对非综合征性颅缝早闭症手术干预的经验。他们从围手术期结果以及术后并发症和再次手术的相关风险因素方面评估了开放手术和微创内镜下缝骨切除术。本研究旨在为手术方法的决策提供见解，并为该领域未来的前瞻性研究奠定基础。
在这项回顾性队列研究中，分析了2014年至2024年在作者所在中心接受初次手术的所有非综合征性颅缝早闭症患者的病历。作者基于麻醉时间、住院时间、血液学参数、术后输血量以及头围百分位数（HCP）的变化来评估开放手术和内镜下缝骨切除术。对6个月以下不同类型颅缝早闭症的患者进行了亚组分析。进一步调查以确定术后并发症和再次手术的潜在风险因素。
本研究共纳入633例接受非综合征性颅缝早闭症治疗的儿科患者（281例行内镜下缝骨切除术，352例行开放手术）。这些数据表明内镜手术呈上升趋势。作者所在中心于2014年开始进行内镜手术，到2024年，75%的颅缝早闭症患者接受了该手术（p < 0.001）。与开放手术组相比，内镜组患者的麻醉时间更短（p < 0.001）、住院时间缩短（p < 0.001）且输血量更低（p < 0.001）；然而，在亚组分析中输血量差异不显著。亚组分析显示矢状缝（p = 0.4）和冠状缝（p = 0.85）颅缝早闭症患者的HCP变化相当。相比之下，额缝（p = 0.03）和多缝（p = 0.04）颅缝早闭症患者开放手术后的变化更大。两组术后并发症发生率（内镜组6.4%，开放手术组4.5%）和再次手术率（内镜组4.6%，开放手术组2.8%）相当。在单因素分析中，较高体重（OR 1.07，p < 0.05）被确定为术后并发症的唯一风险因素，这可归因于手术干预延迟。冠状缝（OR 8.38，p < 0.05）和多缝（OR 23.66，p < 0.01）颅缝早闭症与较高的再次手术率相关，而增加桶状板截骨术与较低的再次手术率相关（OR 0.22，p < 0.05）。
与开放手术相比，内镜下缝骨切除术围手术期结果可接受，并发症和再次手术率相当。亚组分析支持了这些发现。然而,由于不同类型颅缝早闭症的手术结果存在差异，因此需要进一步关注颅骨测量结果的研究。
