Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution

Han, Rowland H.; Nguyen, Dennis C.; Bruck, Brent S.; Skolnick, Gary B.; Yarbrough, Chester K.; Naidoo, Sybill D.; Patel, Kamlesh B.; Kane, Alex A.; Woo, Albert S.; Smyth, Matthew D.

doi:10.3171/2015.7.peds15187

Cited by 123Craniofacial Disorders and TreatmentsNeurosurgical Procedures and ComplicationsPectus Deformity Diagnosis and Treatment

Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution

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Han, Rowland H., Nguyen, Dennis C., Bruck, Brent S., Skolnick, Gary B., Yarbrough, Chester K., Naidoo, Sybill D., Patel, Kamlesh B., Kane, Alex A. +2 more·2016·Journal of Neurosurgery: Pediatrics

DOI 10.3171/2015.7.peds15187PMC PMC4775423

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Abstract

OBJECT: The authors present a retrospective cohort study examining complications in patients undergoing surgery for craniosynostosis using both minimally invasive endoscopic and open approaches. METHODS: Over the past 10 years, 295 nonsyndromic patients (140 undergoing endoscopic procedures and 155 undergoing open procedures) and 33 syndromic patients (endoscopic procedures in 10 and open procedures in 23) met the authors’ criteria. Variables analyzed included age at surgery, presence of a preexisting CSF shunt, skin incision method, estimated blood loss, transfusions of packed red blood cells, use of intravenous steroids or tranexamic acid, intraoperative durotomies, procedure length, and length of hospital stay. Complications were classified as either surgically or medically related. RESULTS: In the nonsyndromic endoscopic group, the authors experienced 3 (2.1%) surgical and 5 (3.6%) medical complications. In the nonsyndromic open group, there were 2 (1.3%) surgical and 7 (4.5%) medical complications. Intraoperative durotomies occurred in 5 (3.6%) endoscopic and 12 (7.8%) open cases, were repaired primarily, and did not result in reoperations for CSF leakage. Similar complication rates were seen in syndromic cases. There was no death or permanent morbidity. Additionally, endoscopic procedures were associated with significantly decreased estimated blood loss, transfusions, procedure length, and length of hospital stay compared with open procedures. CONCLUSIONS: Rates of intraoperative durotomies and surgical and medical complications were comparable between endoscopic and open techniques. This is the largest direct comparison to date between endoscopic and open interventions for synostosis, and the results are in agreement with previous series that endoscopic surgery confers distinct advantages over open surgery in appropriate patient populations.

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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.
“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 [12]
The Abstract Results report no mortality in either the endoscopic or open group, so this study does not show a significantly lower mortality rate with endoscopic surgery. The Conclusions report lower blood loss and shorter procedures with endoscopic surgery, but do not attribute a mortality difference to reduced surgical trauma. (LLM, conf=0.90)
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Endoscopic procedures are particularly advantageous when performed early in life.
“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 [12]
Due to the advanced age of open surgical approaches and more complex findings, potentially more difficult extensive operations must be performed compared with younger children who may be operated on with less pronounced findings.
“However, it should be noted at this point that due to the advanced age of open surgical approaches and the more complex findings, potentially more difficult extensive operations must be performed compared to younger children who may be operated on with less pronounced findings [12].”
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 [12]

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RETRACTED CHAPTER: Craniosynostosis: Endoscopically Versus Open Treatment
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Authors: Han, R. H., Nguyen, D. C., Bruck, B. S., Skolnick, G. B., Yarbrough, C. K., Naidoo, S. D., Patel, K. B., Kane, A. A., Woo, A. S., & Smyth, M. D.
Affiliations: Department of Neurological Surgery and
Washington University in St. Louis (US)
The University of Texas Southwestern Medical Center (US)
ORCID: Han, Rowland H.
Skolnick, Gary B.
Yarbrough, Chester K.
Naidoo, Sybill D.
Patel, Kamlesh B.
Kane, Alex A.
Smyth, Matthew D.
Venue: Journal of Neurosurgery: Pediatrics
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Published: 2016-03
Volume: 17
Issue: 3
Pages: 361-370
ISSN: 1933-0707 (ISSN-L)
1933-0715
DOI: 10.3171/2015.7.peds15187
PMC: PMC4775423
OpenAlex: W2181195897
Cited by: 123
References: 35
Citations by year: 2026: 7 · 2025: 19 · 2024: 15 · 2023: 13 · 2022: 15 · 2021: 10 · 2020: 15 · 2019: 9 · 2018: 10 · 2017: 8 · 2016: 2
FWCI: 4.56
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Neurosurgery Pediatrics (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (UL1TR000448, TL1TR000449)
National Center for Advancing Translational Sciences
Topics: Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
Health Sciences › Medicine › Neurology › Neurosurgical Procedures and Complications
Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
Keywords: craniosynostosis, endoscopic craniosynostosis surgery, surgical complications, syndromic craniosynostosis, nonsyndromic craniosynostosis, blood loss, blood transfusion, length of hospital stay, cerebrospinal fluid shunt
MeSH terms: Child, Child, Preschool, Craniosynostoses, Humans, Infant, Infant, Newborn, Missouri, Postoperative Complications, Reoperation, Retrospective Studies, Treatment Outcome, Minimally Invasive Surgical Procedures, Plastic Surgery Procedures

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Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution

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