S5A-05 SESSION 5A: GENERALITIES IN CRANIOSYNOSTOSIS – PART II LARGE SINGLE INSTITUTION SERIES OF ENDOSCOPICALLY TREATED INFANTS WITH CRANIOSYNOSTOSIS

Abstract

Introduction: Endoscopic strip craniectomy (ESC) followed by helmeting for the treatment of craniosynostosis has gained increasing popularity since its introduction in the 1990s. Efficacy and safety remains to be determined. Methods: 500 consecutive infants who underwent ESC for craniosynostosis at a single institution from 2004 to 2018 by a single neurosurgeon were identified from a prospective database. Patient demographics, operative and postoperative variables were analyzed. Results: 500 infants (69% male) of median (IQR) age 3.0 (1.1–16.7) months and weight 5.9 (IQR 5.6–6.7) kg underwent ESC over the 15 year period. Median operative and anesthesia times were 47 and 140 minutes, respectively. Median length of hospital stay was 1 (IQR 1-1) day (3.2% admitted to ICU). The transfusion rate was 6.6% (95% CI: 5–9%) and postoperative complication rate was 1.4% (95% CI: 1–3%). Risk factors for blood transfusion were identified by multivariable logistic regression and included syndromic craniosynostosis (P=.01) and multiple fused sutures (P=.02). Complications included surgical site infections (n=4), skull defect (n=2), and CSF leak (n=1). 14 patients (2.8%; 95% CI: 2–5%) ultimately required an open procedure for correction of their craniosynostosis due to suture (re-)fusion (n=12) or inadequate cosmetic result (n=2). Infants with sagittal, coronal, and multi-suture craniosynostosis showed normalization of head circumference postoperatively at 12 months of age relative to World Health Organization normal head growth data (all P<.001, paired t-test). Head circumference remained within ±25 percentile points of baseline (WHO percentile) in 81% (95% CI: 77–84%) of infants by 12 months of age, decreasing by >25 in 7% (95%CI: 5–10%) and increasing by >25 in 12% (95% CI: 10–15%). Follow-up data demonstrated compliance with the recommended helmet therapy in 91.4% of patients (5.4% unknown); prior data from this cohort showed an average of 7 months of helmet therapy to achieve satisfactory correction. Conclusion: ESC is a safe, effective, and durable procedure for the correction of craniosynostosis in infants. ESC offers a short length of stay, low complication and transfusion rates, and excellent clinical outcomes including age-appropriate normalization of postoperative head growth in >90% of infants.