Endoscopic Versus Open Cranial Reconstruction Surgery for Anterior Craniosynostosis: Experience from South-East Asia

Abstract

Introduction and objective: Craniosynostosis is a pathological condition resulting from premature closure of cranial sutures. Open cranial vault reconstruction has been the standard of care for isolated non-syndromic craniosynostosis. The current centre introduced the endoscopic craniosynostosis surgery in 2015. The aim of the study is to compare safety outcomes of endoscopic versus open surgery in craniosynostosis within the context of a developing healthcare system, with a focus on anterior synostosis. Methods: This was a retrospective study of all patients undergoing surgery for anterior craniosynostosis from 2012 to 2018 at a single institution. Data on age at surgery, demographics, sutures, surgery duration and complications, including follow up information was obtained. We excluded syndromic patients and patients with pan-synostosis. Statistical analysis was undertaken with P value set at <.05. Results: There were totally 40 patients who underwent craniosynostosis surgery. Seventeen patients underwent endoscopic correction, and 23 open procedures. Metopic and coronal suture patients were equally distributed, with an equal sex distribution. The mean age at surgery in the endoscopic group was 3.7 months (3-5) and higher at 11.5 months (8-18) in the open group ( P < .05). The duration of surgery, blood loss and overall length of hospital stay were significantly reduced in the endoscopic group ( P < .05). In the endoscopic cohort, patients with metopic synostosis obtained complete correction, while patients with unicoronal synostosis had minor residual frontal asymmetry. There were no immediate post-operative complications in the endoscopic group, but the open surgery cohort had minor dural tears in 6 patients. Conclusion: The endoscopic technique has a better safety profile than open surgery for craniosynostosis and results in a complete correction in patients with metopic and bicoronal craniosynostosis.