Crofts Helen, Mankowski Peter, Tamber Mandeep, Courtemanche Douglas J
University of British Columbia, Department of Surgery, Division of Plastic Surgery, Vancouver. Canada.
University of British Columbia, Department of Surgery, Division of Neurosurgery (MT), Vancouver. Canada.
Plast Surg (Oakv). 2025 May;33(2):283-288. doi: 10.1177/22925503231184262. Epub 2023 Jul 10.
Nonsyndromic sagittal craniosynostosis is treated surgically to improve skull cosmesis and to decrease the risk of raised intracranial pressure. The purpose of this study is to compare the outcomes of two current surgical techniques for craniosynostosis treatment, open and endoscopic strip craniectomy. A single institution retrospective chart review was conducted of patients with nonsyndromic sagittal craniosynostosis treated surgically from 2011 to 2016. Patients were divided into two groups based on surgical technique: open or endoscopic strip craniectomy. The head shape was assessed using pre- and postoperative cephalic index (CI). Complications and operative details were compared. Mean absolute CI over time and 95% confidence intervals were graphed. A total of 51 children (36 male, 15 female; 13 open, 38 endoscopic) were included with an average length of follow-up of 27.2 months (range 4-60). The median age at surgery was 4.0 months for open and 3.0 months for endoscopic. There was no significant difference in preoperative CI between endoscopic and open groups (0.67 vs 0.66). The largest improvements in CI were seen 3 to 6 months postoperatively. There was a significant improvement in postoperative CI for both groups (endoscopic 0.75, = .02; open = 0.74, < .01). From maximal postoperative CI to >2 year follow up there was no significant regression in CI for the endoscopic group ( = .12) and a small regression for the open group (-0.02, = .01). There were no transfusions, brain injuries, or deaths. Patients in the endoscopic group had significantly less blood loss intraoperatively ( = .01) and a significantly shorter duration of hospital stay compared to the open group ( < .001). Endoscopic and open surgical techniques are both effective treatments for nonsyndromic sagittal synostosis, with no difference in initial postoperative CI. These findings support the use of either technique and corroborate previous literature.
非综合征性矢状缝早闭通过手术治疗以改善颅骨美观并降低颅内压升高的风险。本研究的目的是比较两种当前用于治疗颅缝早闭的手术技术，即开放性和内镜下条带颅骨切除术的效果。对2011年至2016年接受手术治疗的非综合征性矢状缝早闭患者进行了单机构回顾性病历审查。根据手术技术将患者分为两组：开放性或内镜下条带颅骨切除术。使用术前和术后头指数（CI）评估头部形状。比较并发症和手术细节。绘制了随时间变化的平均绝对CI及其95%置信区间。共纳入51名儿童（36名男性，15名女性；13例行开放性手术，38例行内镜手术），平均随访时间为27.2个月（范围4 - 60个月）。开放性手术组手术时的中位年龄为4.0个月，内镜手术组为3.0个月。内镜组和开放性手术组术前CI无显著差异（0.67对0.66）。术后3至6个月CI改善最大。两组术后CI均有显著改善（内镜组0.75，P = 0.02；开放性手术组0.74，P < 0.01）。从术后最大CI到随访超过2年，内镜组CI无显著下降（P = 0.12），开放性手术组有小幅下降（-0.02，P = 0.01）。无输血、脑损伤或死亡情况。内镜组患者术中失血量显著较少（P = ＞0.01），与开放性手术组相比住院时间显著更短（P ＜ 0.001）。内镜和开放性手术技术都是治疗非综合征性矢状缝早闭的有效方法，术后初始CI无差异。这些发现支持使用任何一种技术，并与先前的文献一致。
