Endoscopic treatment of sagittal suture synostosis — a critical analysis of current management strategies
Open accessAbstract
While many centers nowadays offer minimally invasive techniques for the treatment of single suture synostosis, surgical techniques and patient management vary significantly. We provide an overview of how scaphocephaly treated with endoscopic techniques is managed in the reported series and analyze the crucial steps that need to be dealt with during the management process. We performed a review of the published literature including all articles that examined sagittal-suture synostosis treated with endoscopic techniques as part of single- or multicenter studies. Fourteen studies reporting results of 885 patients were included. We identified 5 key steps in the management of patients. A total of 188 patients were female and 537 male (sex was only specified in 10 articles, for 725 included patients, respectively). Median age at surgery was between 2.6 and 3.9 months with a total range from 1.5 to 7.0 months. Preoperative diagnostics included clinical and ophthalmologic examinations as well as neuropsychological and genetic consultations if needed. In 5 publications, a CT scan was routinely performed. Several groups used anthropometric measurements, mostly the cephalic index. All groups analyzed equally recommended to perform endoscopically assisted craniosynostosis surgery with postoperative helmet therapy in children < 3 months of age, at least for non-syndromic cases. There exist significant variations in surgical techniques and patient management for children treated endoscopically for single suture sagittal synostosis. This heterogeneity constitutes a major problem in terms of comparability between different strategies.
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Springs must be removed in a separate procedure once the treatment goal has been achieved.
“In addition, they must be removed in a separate procedure once the treatment goal has been achieved [61, 74, 75].”
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 [74]
The Discussion > Surgery passage says that spring-assisted surgery requires a second procedure to remove the springs. It does not specify that removal occurs once the treatment goal has been achieved; the follow-up passages discussing treatment goals concern helmet therapy, not springs. Page numbers were not provided in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSpring-assisted cranioplasty requires a secondary procedure for spring removal.
“In contrast, Rodgers et al. reported that while the technique yielded modest CI improvement, it required a secondary procedure for spring removal [61, 74, 75] and carried a risk of complications, including cerebrospinal fluid leaks and reoperations, in a cohort of 100 cases [63].”
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 [74]
SMC compared with SC showed a longer hospitalisation period.
“The results of SMC compared with SC showed comparable transfusion-free hospital courses, but a longer hospitalisation period was observed.”
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 [74]
In General considerations > Step 4: Postoperative management (page unavailable), the paper says hospital stays were very similar across the endoscopic series it reviewed, with discharge after one day on average. Discussion > Surgery (page unavailable) says spring-assisted surgery was not part of that series. The copy does not compare SMC with SC on hospital stay or transfusion-free courses. (LLM, conf=0.77)
Experimental — accuracy not yet measuredSpring-mediated cranioplasty (SMC) compared with strip craniectomy (SC) showed comparable transfusion-free hospital courses.
“The results of SMC compared with SC showed comparable transfusion-free hospital courses, but a longer hospitalisation period was observed.”
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 [74]
The Discussion > Surgery passage says spring-assisted surgery was not part of the reviewed series; its statement that results are similar to those of endoscopic procedures does not address transfusion-free hospital courses. The Step 3: Surgery transfusion table and Step 4: Postoperative management hospital-stay passage report findings for the reviewed procedures, but neither compares SMC with SC on transfusions or length of stay. Page numbers were not available in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measured
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- Authors
- Fassl, V., Ellermann, L., Reichelt, G., Pape, P., Blecher, C., Hoffmann, C., Ringel, F., Al-Nawas, B., Heider, J., & Ottenhausen, M.
- Affiliations
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Corresponding author
- Ottenhausen, Malte
- Venue
- Neurosurgical Review
- Published
- 2022-04-06
- Volume
- 45
- Issue
- 4
- Pages
- 2533-2546
- ISSN
- 0344-5607 (ISSN-L)
- 1437-2320
- PMC
- PMC9349114
- OpenAlex
- W4225875623
- Cited by
- 17
- References
- 49
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 7 · 2023: 2
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Neurosurgical Review (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Gutenberg Open Science (publishedVersion, cc-by)
- Gutenberg Open Science (cc-by)
- Funders
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Keywords
- sagittal synostosis, endoscopic craniosynostosis surgery, scaphocephaly, helmet therapy, preoperative diagnosis, cephalic index, anthropometry, pediatric neurosurgery, surgical technique variation, syndromic craniosynostosis
- MeSH terms
- Child, Cranial Sutures, Craniosynostoses, Craniotomy, Endoscopy, Female, Humans, Infant, Male, Postoperative Period, Sutures, Treatment Outcome
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