A Comparison of Endoscopic-Assisted and Open Fronto-Orbital Distraction for the Treatment of Unicoronal Craniosynostosis

Abstract

Background: Fronto-orbital distraction osteogenesis (FODO) is an established surgical technique for patients with unicoronal craniosynostosis. Our institution has employed an endoscopic-assisted “endo-FODO” in recent years to decrease cutaneous scarring and lessen our impact on the functional growth matrix. This study compares perioperative outcomes in patients undergoing endo-FODO to those undergoing the procedure with a traditional coronal approach. Methods: Patients with unicoronal craniosynostosis undergoing FODO from 2013-2023 were included. Patients were grouped by whether they underwent FODO with an endoscopic-assisted technique or a traditional coronal incision. Operative time, estimated blood loss, transfusion volume, and length of hospitalization were compared. Cutaneous scarring at one year postoperatively was assessed with the Scar Cosmesis Assessment and Rating (SCAR) scale. Results: Twenty-seven patients (18 traditional, 9 endoscopic-assisted) were included. Patients were 5.6 (interquartile range 5.1-6.3) months old at surgery with no difference between groups (p=0.999). Operative time was 114 minutes (92-122) for traditional FODO and 104 minutes (95-112) for endo-FODO (p=0.607). Time under anesthesia was shorter for endo-FODO (traditional: 243 minutes (218-264), endo-FODO: 210 minutes (191-224), p=0.029). Transfusion volume was 12.2mL/kg lower for endo-FODO compared to traditional FODO (p=0.001). Length of stay was similar between groups (p=0.678). SCAR ratings were 1.83 (1.1-4.47) in traditional FODO compared to 1.00 (0.58-1.67) in endo-FODO (p=0.036). Conclusions: Endo-FODO was associated with reduced time under anesthesia, reduced transfusion requirements, and improved SCAR scores without a change in operative duration, perioperative complications, or length of stay. Future work will compare functional and aesthetic outcomes between techniques.