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Endoscopic versus open approach in craniosynostosis repair: a systematic review and meta-analysis of perioperative outcomes
Abstract
Introduction Surgery for craniosynostosis remains a crucial element in successful management. Intervention by both endoscopic and open approaches has been proven effective. Given the differences in timing and indications for these procedures, differences in perioperative outcomes have yet to be thoroughly compared between the two approaches. The aim of the systematic review and meta-analysis was to assess the available evidence of perioperative outcomes between the two approaches in order to better influence the management paradigm of craniosynostosis.Methods We followed recommended PRISMA guidelines for systematic reviews. Seven electronic databases were searched to identify all potentially relevant studies published from inception to February 2018 which were then screened against a set of selection criteria. Data were extracted and analyzed using meta-analysis of proportions.Results Twelve studies satisfied all the selection criteria to be included, which described a pooled cohort involving 2064 craniosynostosis patients, with 965 (47%) and 1099 (53%) patients undergoing surgery by endoscopic and open approaches respectively. When compared to the open approach, it was found that the endoscopic approach conferred statistically significant reductions in blood loss (MD = 162.4 mL), operative time (MD = 112.38 min), length of stay (MD = 2.56 days), and rates of perioperative complications (OR = 0.58), reoperation (OR = 0.37) and transfusion (OR = 0.09), where all p < 0.001.Conclusion Both endoscopic and open approaches for the surgical management of craniosynostosis are viable considerations. The endoscopic approach confers a significant reduction in operative and postoperative morbidity when compared to the open approach. Given that specific indications for either approach should be considered when managing a patient, the difference in perioperative outcomes remain an important element of this paradigm. Future studies will validate the findings of this study and consider long-term outcomes, which will all contribute to rigor of craniosynostosis management.
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“Endoscopic surgery demonstrates a significantly lower mortality rate compared to open techniques, attributed to its minimally invasive nature and reduced surgical trauma.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [13]
In the citing paper
“Endoscopic procedures are particularly advantageous when performed early in life, as they involve smaller incisions and facilitate quicker recovery [12–15].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [13]
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Metadata
- Authors
- Goyal, A., Lu, V. M., Yolcu, Y. U., Elminawy, M., & Daniels, D. J.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Daniels, David J.
- Venue
- Child's Nervous System
- Published
- 2018-06-30
- Volume
- 34
- Issue
- 9
- Pages
- 1627-1637
- ISSN
- 0256-7040 (ISSN-L)
- 1433-0350
- OpenAlex
- W2810060657
- Cited by
- 106
- References
- 32
- Citations by year
- 2026: 18 · 2025: 18 · 2024: 19 · 2023: 16 · 2022: 16 · 2021: 5 · 2020: 9 · 2019: 5
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Child s Nervous System (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Keywords
- craniosynostosis, perioperative outcomes, operative time, blood loss, length of hospital stay, postoperative complications, reoperation, blood transfusion
- MeSH terms
- Craniosynostoses, Craniotomy, Humans, Prospective Studies, Retrospective Studies, Treatment Outcome, Minimally Invasive Surgical Procedures, Plastic Surgery Procedures, Neuroendoscopy, Observational Studies as Topic
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