Comparison of Outcomes for Endoscopic Simple Strip Craniectomy versus Endoscopic Strip Craniectomy with Wedge Osteotomies for Treatment of Sagittal Craniosynostosis

Objective: Endoscopic strip craniectomy is a safe and effective treatment for sagittal craniosynostosis in patients less than 4 months old. Although different correction techniques have been described, the most optimal approach remains controversial. This study was performed to compare early outcomes in children undergoing endoscopic strip craniectomy alone versus with bifrontal and biparietal limited or extended wedge osteotomies. Methods: A retrospective IRB-approved chart review was performed on patients with sagittal craniosynostosis treated with minimally invasive strip craniectomy at Children’s Hospital of Michigan in 2009-2022. Operative outcomes of endoscopic strip craniectomy alone (ESC), with limited osteotomies (ESC+LO), or with extended wedge osteotomies (ESC+EO) were compared. All patients underwent postoperative helmet molding therapy. Pre- and post-operative (at 6 weeks, 3 months, 6 months, and 1 year) cephalic indices (CI) were evaluated. Postoperative CI of 75-80 was graded as good result, and greater than 80 as excellent. Results: A total of 31 patients were included in this study; 7 were treated with ESC, 12 with ESC+LO, and 12 with ESC+EO. Mean age at surgery was 2.67 months. Overall, preoperative mean CI was 70.06 (62-81) and postoperative was 77.32 (68-84) at one year, with 17 of the 20 patients (85%) achieving good postoperative CI ≥75 and 5 patients (25%) achieving excellent postoperative CI >80. When assessing early outcomes, mean CI for ESC+LO group was significantly greater than that of ESC alone at 3 months (p=0.036) and 6 months (p=0.042) postoperatively; mean CI for ESC+EO was also significantly greater than that of ESC alone at 3 mo. (p=0.018) and 6 mo. (p=0.047). More dramatic percent increases in CI could be observed in ESC+EO at early time points (16.58% at 3 mo. and 15.14% at 6 mo.) and ESC+LO (13.95% at 3 mo. and 13.58% at 6 mo.) when compared to that of the ESC alone group (8.01% and 10.07% respectively). Conclusions: When comparing amongst the three techniques, endoscopic strip craniectomy with either degree of wedge osteotomies has more dramatic effect on changes in cephalic indices in early time points up to six-month follow-up period. Majority of patients were able to achieve satisfactory normalization of head shape as demonstrated by postoperative mean CI ≥75. Corresponding author: Arlene Rozzelle, MD, 3901 Beaubien Blvd, Detroit, MI 48201, [email protected], 313-745-0247