Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience: Clinical article

Shah, Manish N.; Kane, Alex A.; Petersen, J. Dayne; Woo, Albert S.; Naidoo, Sybill D.; Smyth, Matthew D.

doi:10.3171/2011.5.peds1128

Cited by 183Craniofacial Disorders and TreatmentsPectus Deformity Diagnosis and TreatmentReconstructive Facial Surgery Techniques

Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience: Clinical article

Shah, Manish N., Kane, Alex A., Petersen, J. Dayne, Woo, Albert S., Naidoo, Sybill D., Smyth, Matthew D.·2011·Journal of Neurosurgery: Pediatrics

DOI 10.3171/2011.5.peds1128

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Abstract

Object: This study investigated the differences in effectiveness and morbidity between endoscopically assisted wide-vertex strip craniectomy with barrel-stave osteotomies and postoperative helmet therapy versus open calvarial vault reconstruction without helmet therapy for sagittal craniosynostosis. Methods: Between 2003 and 2010, the authors prospectively observed 89 children less than 12 months old who were surgically treated for a diagnosis of isolated sagittal synostosis. The endoscopic procedure was offered starting in 2006. The data associated with length of stay, blood loss, transfusion rates, operating times, and cephalic indices were reviewed. Results: There were 47 endoscopically treated patients with a mean age at surgery of 3.6 months and 42 patients with open-vault reconstruction whose mean age at surgery was 6.8 months. The mean follow-up time was 13 months for endoscopic versus 25 months for open procedures. The mean operating time for the endoscopic procedure was 88 minutes, versus 179 minutes for the open surgery. The mean blood loss was 29 ml for endoscopic versus 218 ml for open procedures. Three endoscopically treated cases (6.4%) underwent transfusion, whereas all patients with open procedures underwent transfusion, with a mean of 1.6 transfusions per patient. The mean length of stay was 1.2 days for endoscopic and 3.9 days for open procedures. Of endoscopically treated patients completing helmet therapy, the mean duration for helmet therapy was 8.7 months. The mean pre- and postoperative cephalic indices for endoscopic procedures were 68% and 76% at 13 months postoperatively, versus 68% and 77% at 25 months postoperatively for open surgery. Conclusions: Endoscopically assisted strip craniectomy offers a safe and effective treatment for sagittal craniosynostosis that is comparable in outcome to calvarial vault reconstruction, with no increase in morbidity and a shorter length of stay.

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Shah et al. found that endoscopic surgery allowed significantly shorter postoperative hospitalisation (1.2 days vs 3.9 days).
“but also allowed a significantly shorter postoperative hospitalisation (1.2 days compared to 3.9 days in open procedures).”
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 [58]
Shah et al. found that endoscopic surgery had significantly lower mean blood loss (29 ml vs 218 ml) and lower transfusion rate compared to open surgery.
“The endoscopic method not only showed a significantly lower mean blood loss (29 ml compared to 218 ml in the open method) and a lower transfusion rate (all openly operated children received one, whereas only 3 endoscopically operated children received one)”
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 [58]
Shah et al. found that pre- and postoperative CI after 13 months were comparable in endoscopically treated children (68% and 76%), while open procedures had comparable CI values after 25 months (68% and 77%).
“It is also noteworthy that the pre- and postoperative CI after 13 months were comparable in the endoscopically treated children (68% and 76%), while the open procedures had comparable CI values after 25 months (68% and 77%) [58].”
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 [58]
Endoscopic procedures have the advantage of requiring fewer skin incisions and less blood loss and are considered less invasive and more child-friendly.
“They have the advantage of requiring fewer skin incisions and less blood loss and are therefore considered less invasive and more child-friendly [64,65,66,67,68,69,70].”
From Isolated Sagittal Craniosynostosis: A Comprehensive Review (2024) · cites this paper as [68]

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Authors: Shah, M. N., Kane, A. A., Petersen, J. D., Woo, A. S., Naidoo, S. D., & Smyth, M. D.
Affiliations: Departments of Neurological Surgery and
The University of Texas Southwestern Medical Center (US)
University of Oklahoma Medical Center (US)
Washington University in St. Louis (US)
Corresponding author: Shah, Manish N.
ORCID: Shah, Manish N.
Kane, Alex A.
Naidoo, Sybill D.
Smyth, Matthew D.
Venue: Journal of Neurosurgery: Pediatrics
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Published: 2011-08
Volume: 8
Issue: 2
Pages: 165-170
ISSN: 1933-0707 (ISSN-L)
1933-0715
DOI: 10.3171/2011.5.peds1128
OpenAlex: W1661865313
Cited by: 183
References: 36
Citations by year: 2026: 8 · 2025: 15 · 2024: 16 · 2023: 15 · 2022: 16 · 2021: 15 · 2020: 15 · 2019: 11 · 2018: 15 · 2017: 10 · 2016: 11 · 2015: 12 · 2014: 14 · 2013: 4 · 2012: 3
FWCI: 4.58
Type: journal article
Language: en
Open access: closed
Locations: Journal of Neurosurgery Pediatrics (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5t32ns007205-32)
National Institute of Neurological Disorders and Stroke (T32-NS007205)
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 craniosynostosis, endoscopic strip craniectomy, helmet therapy, postoperative morbidity, surgical outcomes, infants, cephalic index, length of hospital stay, blood loss
MeSH terms: Blood Transfusion, Craniosynostoses, Craniotomy, Endoscopy, Female, Head Protective Devices, Hospitals, Pediatric, Humans, Length of Stay, Male, Morbidity, Osteotomy, Postoperative Care, Prospective Studies, Plastic Surgery Procedures

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Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience: Clinical article

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