Minimally Invasive Endoscopic Surgery for Infantile Craniosynostosis: A Longitudinal Cohort Study
Abstract
Objective To evaluate patient outcomes of minimally invasive endoscopic strip craniectomy (ESC) for craniosynostosis.Study design This is a retrospective cohort analysis (2004-2018) of 500 consecutive infants with craniosynostosis treated by ESC with orthotic therapy at a single center. Operative outcomes included transfusions, complications, and reoperations as well as head circumference change based on World Health Organization percentiles. Multivariable logistic regression was used to identify risk factors associated with blood transfusion. Paired t tests were used for within-patient comparisons and Fisher exact test to compare syndromic and nonsyndromic subgroups.Results ESC was associated with low rates of blood transfusion (6.6%), complications (1.4%), and reoperations (3.0%). Risk factors for transfusion included syndromic craniosynostosis (P = .01) and multiple fused sutures (P = .02). Median surgical time was 47 minutes, and hospital length of stay 1 day. Transfusion and reoperation rates were higher among syndromic patients (both P < .001). Head circumference normalized by 12 months of age relative to World Health Organization criteria in infants with sagittal, coronal, and multisuture craniosynostosis (all P < .001).Conclusions ESC is a safe, effective, and durable correction of infantile craniosynostosis. ESC can achieve head growth normalization with low risks of blood transfusion, complications, or reoperation. Early identification of craniosynostosis in the newborn period and prompt referral by pediatricians allows families the option of ESC vs larger and riskier open reconstruction procedures.
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Riordan et al. demonstrated favourable outcomes for infants undergoing ESC.
“Riordan et al. conducted a longitudinal cohort study examining ESC for infantile craniosynostosis, demonstrating favourable outcomes for infants undergoing ESC [55].”
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 [55]
Integration of helmet therapy after endoscopic procedures increased corrective effect, especially for sagittal craniosynostosis.
“The integration of helmet therapy after endoscopic procedures showed an increased corrective effect, especially for the sagittal Craniosynostosis [1, 53, 55, 56].”
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 [55]
Minimally invasive techniques such as ESC are efficacious, particularly in younger patients, and are viable alternatives in the surgical management of craniosynostosis.
“Additionally, Riordan et al. and Gociman et al. supported the efficacy of minimally invasive techniques such as ESC, particularly in younger patients, reinforcing their role as viable alternatives in the surgical management of craniosynostosis [55, 56].”
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 [55]
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- Authors
- Riordan, C. P., Zurakowski, D., Meier, P. M., Alexopoulos, G., Meara, J. G., Proctor, M. R., & Goobie, S. M.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Goobie, Susan M.
- ORCID
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 216
- Pages
- 142-149.e2
- ISSN
- 0022-3476 (ISSN-L)
- OpenAlex
- W2984771983
- Cited by
- 86
- References
- 52
- Citations by year
- 2026: 20 · 2025: 14 · 2024: 12 · 2023: 13 · 2022: 12 · 2021: 9 · 2020: 6
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- R. Michael Scott Research Endowment Fund
- Ingraham Fund for Neurosurgical Research
- 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 › Neurology › Neurosurgical Procedures and Complications
- Keywords
- endoscopic strip craniectomy, minimally invasive surgery, syndromic craniosynostosis, nonsyndromic craniosynostosis, blood transfusion, postoperative complications, reoperation, head circumference, orthotic treatment, sagittal craniosynostosis, coronal craniosynostosis, risk factors
- MeSH terms
- Craniosynostoses, Craniotomy, Endoscopy, Female, Humans, Infant, Longitudinal Studies, Male, Retrospective Studies, Cohort Studies, Treatment Outcome
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