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Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution
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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.”
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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“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]
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“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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Medina‐Pizarro, M., Imahiyerobo, T. A., Odigie, E., Guadix, S. W., de Silva, N., Buontempo, M., Souweidane, M. M., & Hoffman, C. E. (2023) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000009485 · Cited by 3
The Outcomes of Endoscopic Suturectomy in Syndromic Craniosynostosis
Shim, Y., Kim, S., Ko, J. M., Jeon, S., Kim, B. J., Jung, J. H., Lee, S., Kim, K. H., Lee, J. Y., & Phi, J. H. (2023) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000009835 · Cited by 3
Furtado, L. M. F., Filho, J. A. D. C. V., Mourão, R. T. N. D. G., Júnior, L. C. D. S., Filho, G. D. M. M., & Pedrosa, L. D. (2020) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000007017 · Cited by 3
Delayed Chronic Subdural Hematoma after Total Cranial Vault Reconstruction for Sagittal Synostosis
Pasarikovski, C. R., Abel, T. J., Forrest, C. R., Dirks, P. B., & Ibrahim, G. M. (2018) · Pediatric Neurosurgery · doi:10.1159/000487809 · Cited by 3
Hermann, J., Raak, C. K., Ostermann, T., & Scharbrodt, W. (2025) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-025-03978-9 · Cited by 2
“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].”
Prospective Evaluation of Health-Related Quality-of-Life in Children with Craniosynostosis
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Başağaoğlu, B., Cyr, G. S., Dempsey, R. F., Dauser, R. C., Lam, S. K., & Maricevich, R. S. (2019) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000006036 · Cited by 2
Novel Suturectomy Using Absorbable Plates in Early Surgery for Craniosynostosis
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Gırgın, F. İ., Abdullayev, R., Şakar, M., Dağçınar, A., & Öztürk, M. (2024) · Child s Nervous System · doi:10.1007/s00381-024-06682-4 · Cited by 2
Fearon, J. A. (2019) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000005384 · Cited by 2
Discussion: Transverse Distraction Osteogenesis for Posterior Narrowing of the Cranial Vault
Patel, K. B., & Linkugel, A. D. (2022) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000008948 · Cited by 1
Self-citationAlterations in Sphenoid Anatomy in Craniosynostosis: Implications for Fronto-Orbital Advancement
Santiago, G. S., Santiago, C. N., Nguyen, A., Choudhary, A., Zhao, L., Alkureishi, L. W. T., Patel, P. K., & Purnell, C. A. (2024) · The Cleft Palate-Craniofacial Journal · doi:10.1177/10556656241245514 · Cited by 1
Fundamentals of Non-Syndromic Craniosynostosis
Malagón-Hidalgo, H. O., & Monroy-Cedillo, J. L. (2024) · Springer eBooks · doi:10.1007/978-3-031-61894-9_23 · Cited by 1
Morphology and outcomes in combined sagittal and unilateral coronal synostosis
Tandon, D., Burton, J. S., Karsten, M. B., Skolnick, G. B., Naidoo, S. D., Proctor, M. R., Smyth, M. D., & Patel, K. B. (2025) · Journal of Neurosurgery Pediatrics · doi:10.3171/2024.10.peds24245 · Cited by 1
Self-citationBashiryan, B. A., Satanin, L. A., Gadjieva, O. A., Danilov, G., Strunina, Y. V., Kokaeva, I. K., & Tere, V. A. (2025) · Burdenko s Journal of Neurosurgery · doi:10.17116/neiro202589031114 · Cited by 1
Syndromic vs Nonsyndromic Management of Multisuture Craniosynostosis: A Single-Center Experience
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Flaherty, E., Adegboye, O., & Miranda, B. H. (2026) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000012471 · Cited by 1
Nkhoma, J., Apleni, H., Leballo, G., Chakane, P. M., & Kebalepile, M. M. (2026) · Wits Journal of Clinical Medicine · doi:10.18772/26180197.2026.v8n1a6 · Cited by 1
OPEN RECONSTRUCTIVE METHOD OF SURGICAL TREATMENT OF NONSYNDROMIC CRANIOSYNOSTOSIS IN CHILDREN
Летягин, Г. В., Kim, S. A., Danilin, V. E., Sysoeva, A. A., & Амелин, М. Н. (2018) · Russian journal of neurosurgery · doi:10.63769/1683-3295-2017-0-4-50-58 · Cited by 1
Anesthesia for Minimally Invasive Neurosurgical Procedures in Children
Sethuraman, M., & Nair, P. (2021) · Springer eBooks · doi:10.1007/978-981-16-3376-8_20 · Cited by 2
Variations in Craniosynostosis Surgery Affect Perioperative Outcomes: An Analysis of Peds-NSQIP Data
Hopkins, E. R., Sanchez, R., LEVERSON, G. E., Mount, D. L., & Garland, C. B. (2022) · FACE · doi:10.1177/27325016221097109 · Cited by 1
Surgical Technique in Pediatric Craniofacial Surgery
Furtado, L. M. F., Filho, J. A. D. C. V., dos Santos, A. K. D., Simas, R. T., & Ferreira, J. P. U. (2022) · Archives of Pediatric Neurosurgery · doi:10.46900/apn.v4i2(may-august).111 · Cited by 1
Editorial. Endoscopic synostosis surgery: case closed. Or open? Or in between?
Smyth, M. D. (2018) · Journal of Neurosurgery Pediatrics · doi:10.3171/2018.3.peds18122 · Cited by 1
Self-citationLetter to the Editor: Cranial vault remodeling
Gelabert‐González, M., Echabe, E. A., & Santín-Amo, J. M. (2017) · Journal of Neurosurgery Pediatrics · doi:10.3171/2016.9.peds16550
RETRACTED CHAPTER: Craniosynostosis: Endoscopically Versus Open Treatment
Delye, H. (2019) · Springer eBooks · doi:10.1007/978-3-030-16323-5_10
RetractedPreliminary Report on Endoscopy-assisted Suturectomy for Craniosynostosis
Harada, A., Kyutoku, S., Kimoto, Y., Reina, U., Fujinaga, T., Arita, H., Maeno, K., & Ueda, K. (2020) · Japanese Journal of Neurosurgery · doi:10.7887/jcns.29.498
Metadata
- 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
- Venue
- Journal of Neurosurgery: Pediatrics
- Published
- 2016-03
- Volume
- 17
- Issue
- 3
- Pages
- 361-370
- ISSN
- 1933-0707 (ISSN-L)
- 1933-0715
- 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
- Health Sciences › Medicine › Surgery › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Clinical 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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