Comparison of aesthetic outcomes after endoscopic versus open treatment for sagittal craniosynostosis according to Lausanne classification.

Objective: The aesthetic outcome is one of the major determinants in the performance of surgical corrections of sagittal craniosynostosis. Parental satisfaction is underreported in literature and we used a modified Whitaker classification (Lausanne classification) to improve the stratification of aesthetic outcomes.The aim of this paper is to compare the aesthetic results of open remodelling surgery(ORS) versus endoscope-assisted suturectomy(EAS) for the correction of sagittal craniosynostosis for both surgeons and parents and to validate Lausanne classification.

Methods: Paediatric patients diagnosed with sagittal craniosynostosis and operated by ORS or EAS between 2012 and 2022 were included.The aesthetic satisfaction was assessed using a modified version of the Whitaker classification, namely the Lausanne classification. Epidemiology, clinical and surgical outcomes were retrieved from electronic records and analysed for the two groups.

Results: Forty patients were included in the study. Mean age at surgery was 3.4 months (± SD 0.6) for the EAS group and 7.0 months (± SD 2.0) for the ORS group (p < 0.0001). Aesthetic results were significantly better for the EAS than the ORS for both parents (p = 0.0014) and surgeons (p = 0.0013). Overall length of hospitalisation and length of stay at ICU were significantly shorter for the EAS than the ORS group (p < 0.0001 and p = 0.0007 respectively). We observed no differences in complication rates between the two cohorts.

Conclusions: EAS treatment for sagittal craniosynostosis is a safe technique with better aesthetic results for both parents and surgeons according to Lausanne classification and shorter lengths of stay.