Comparison of Outcomes between Infants above and below 5 Months of Age Undergoing Endoscopic Craniectomy for Sagittal Suture Synostosis.

Abstract

Introduction: Endoscopic strip craniectomy followed by molding helmet therapy for sagittal suture synostosis is thought to be most effective in infants 3-4 months of age. However, infants often present to a neurosurgeon beyond this time period. The aim of this study was to compare morphological outcomes in older infants (5-7 months of age) with younger infants, in a series of babies who were operated endoscopically for sagittal suture synostosis.

Methods: The prospectively maintained Pediatric Neurosurgery Clinical Database at BC Children's Hospital was interrogated and 81 pediatric patients who had undergone an endoscopic craniectomy between 2010 and 2021 for sagittal craniosynostosis and had follow-up of at least 1 year were identified. Eleven of these patients received surgical intervention when they were 5 months of age or older (median 5.4 months, range 5.0-6.4). Morphological indices, duration of helmet therapy, and reoperation rates were compared between the early and late intervention groups.

Results: Both the early intervention (surgery before 5 months of age, n = 70) and the late intervention (surgery at 5 months or later, n = 11) groups had comparable average preoperative cephalic index (CI) (early - 67.1 vs. late - 69.4), change in CI (early - 6.7 vs. late - 4.7), and 2-year follow-up CI (early - 73.8 vs. late - 74.1). Both groups had similar average helmeting duration (6.6 vs. 6.1 months). Of the 11 late intervention patients, none required reoperation but poor cosmetic outcome was noted in 1 patient. The early intervention group had 1 patient who required a secondary cranial vault reconstruction due to persistent scaphocephaly.

Conclusion: Infants who received an endoscopic craniectomy for sagittal suture synostosis after 5 months of age showed no statistically significant difference in morphological outcomes compared to the early intervention group.