Shaping futures: how surgical timing influences outcomes in endoscopic sagittal craniosynostosis repair.

Background: Sagittal craniosynostosis, the most common nonsyndromic craniosynostosis, is primarily treated with surgical intervention to prevent developmental and cosmetic complications. Endoscopic surgical techniques offer a minimally invasive alternative with reduced blood loss, shorter operative times, and faster recovery. However, the influence of age at surgery on clinical outcomes remains unclear.

Methods: A systematic review of 25 studies, encompassing 1606 patients, was conducted to evaluate the relationship between age at surgery and perioperative outcomes. Data extracted included patient demographics, operative times, blood loss, transfusion rates, length of hospital stay (LOS), and postoperative complications. Logistic regression models were utilized to assess the association between patient age and outcomes.

Results: The mean age at surgery was 3.3 months (range = 1.6-5.6 months), with males comprising 73.3% of the cohort. Older age at surgery trended towards increased transfusion rates and LOS; however, these differences were not statistically significant. The pooled mean for estimated blood loss was 41.0 mL, and the mean operative time was 125.8 min. Complications were rare but included poor hemostasis, dural tears, and postoperative apneic episodes. No significant differences were observed in operative times or long-term outcomes based on age at surgery.

Conclusions: While younger patients undergoing endoscopic sagittal craniosynostosis repair exhibited trends towards improved perioperative metrics, no statistically significant differences were noted. These findings suggest that endoscopic repair remains a viable option across a range of early ages. Further prospective studies are needed to refine guidelines for optimal surgical timing and improve reporting on long-term outcomes.