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Cited by 39Craniofacial Disorders and TreatmentsPectus Deformity Diagnosis and TreatmentNeurosurgical Procedures and Complications

Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience

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Dalle Ore, Cecilia L., Dilip, Monisha, Brandel, Michael G., McIntyre, Joyce K., Hoshide, Reid, Calayag, Mark, Gosman, Amanda A., Cohen, Steven R. +1 more·2018·Journal of Neurosurgery: Pediatrics
DOI 10.3171/2018.2.peds17364
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Abstract

OBJECTIVE: In this paper the authors review their 16-year single-institution consecutive patient experience in the endoscopic treatment of nonsyndromic craniosynostosis with an emphasis on careful review of any associated treatment-related complications and methods of complication avoidance, including preoperative planning, intraoperative management, and postoperative care and follow-up. METHODS: A retrospective chart review was conducted on all patients undergoing endoscopic, minimally invasive surgery for nonsyndromic craniosynostosis at Rady Children’s Hospital from 2000 to 2015. All patients were operated on by a single neurosurgeon in collaboration with two plastic and reconstructive surgeons as part of the institution’s craniofacial team. RESULTS: Two hundred thirty-five patients underwent minimally invasive endoscopic surgery for nonsyndromic craniosynostosis from 2000 to 2015. The median age at surgery was 3.8 months. The median operative and anesthesia times were 55 and 105 minutes, respectively. The median estimated blood loss (EBL) was 25 ml (median percentage EBL 4.2%). There were no identified episodes of air embolism or operative deaths. One patient suffered an intraoperative sagittal sinus injury, 2 patients underwent intraoperative conversion of planned endoscopic to open procedures, 1 patient experienced a dural tear, and 1 patient had an immediate reexploration for a developing subgaleal hematoma. Two hundred twenty-five patients (96%) were admitted directly to the standard surgical ward where the median length of stay was 1 day. Eight patients were admitted to the intensive care unit (ICU) postoperatively, 7 of whom had preexisting medical conditions that the team had identified preoperatively as necessitating a planned ICU admission. The 30-day readmission rate was 1.7% (4 patients), only 1 of whom had a diagnosis (surgical site infection) related to their initial admission. Average length of follow-up was 2.8 years (range < 1 year to 13.4 years). Six children (< 3%) had subsequent open procedures for perceived suboptimal aesthetic results, 4 of whom (> 66%) had either coronal or metopic craniosynostosis. No patient in this series either presented with or subsequently developed signs or symptoms of intracranial hypertension. CONCLUSIONS: In this large single-center consecutive patient series in the endoscopic treatment of nonsyndromic craniosynostosis, significant complications were avoided, allowing for postoperative care for the vast majority of infants on a standard surgical ward. No deaths, catastrophic postoperative morbidity, or evidence of the development of symptomatic intracranial hypertension was observed.

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Crossref · 10.3171/2018.2.peds17364

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  • Open surgery provides immediate correction but is more invasive, with higher risks of complications such as significant blood loss and scarring.

    “Open surgery provides immediate correction but is more invasive, with higher risks of complications like significant blood loss and scarring [9–11].”

    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 [10]

    The Discussion describes endoscopic repair as minimally invasive and says it commonly requires postoperative cranial molding, supporting a contrast with open surgery. But the paper does not establish that open surgery provides immediate correction or has higher rates of significant blood loss or scarring; its reported bleeding events occurred during endoscopic procedures. Page numbers were not available in our copy. (LLM, conf=0.78)

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  • Endoscopic surgery offers reduced blood loss, shorter operation times, and minimal scarring but often requires postoperative helmet therapy.

    “The endoscopic method offers benefits like reduced blood loss, shorter operation times, and minimal scarring but often requires postoperative helmet therapy.”

    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 [10]

    The Perioperative Data report a median surgical duration of 55.5 minutes and estimated blood loss of 25 ml, while the Discussion describes avoiding prolonged operative times. The introductory passage contrasts shorter endoscopic incisions with open approaches, and Operative and Postoperative Management confirms postoperative cranial orthotics. The paper does not directly establish less blood loss or shorter operations than open surgery, or measure scarring. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Open surgery is associated with significant drawbacks, including greater invasiveness, increased blood loss (a common intra- and postoperative complication), larger bone defects, and more pronounced scarring.

    “In contrast, open surgery provides immediate correction of skull shape but is associated with significant drawbacks, including greater invasiveness, increased blood loss (a common intra- and postoperative complication), larger bone defects, and more pronounced scarring [10, 11].”

    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 [10]

    The introductory passage (labeled Abstract in our copy; page unavailable) describes open approaches as using long, typically ear-to-ear incisions and more involved cranial-vault and skull-base techniques. That supports greater invasiveness and longer incisions, but the paper does not establish that open surgery causes more blood loss, larger bone defects, or more pronounced scarring. Its Discussion describes significant bleeding events in the endoscopic series rather than an open-versus-endoscopic blood-loss comparison. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Open surgery provides immediate correction of skull shape.

    “In contrast, open surgery provides immediate correction of skull shape but is associated with significant drawbacks, including greater invasiveness, increased blood loss (a common intra- and postoperative complication), larger bone defects, and more pronounced scarring [10, 11].”

    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 [10]

    The introductory text (labeled Abstract in our copy; page unavailable) describes open approaches using cranial-vault and skull-base techniques aimed at improving aesthetic outcomes. The Discussion says minimally invasive procedures typically require expansion devices or postoperative molding, but it does not state that open surgery corrects skull shape immediately. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • The endoscopic-assisted method offers advantages such as reduced blood transfusion rates, shorter surgical times, less scarring, and shorter hospital stays.

    “The endoscopic-assisted method offers advantages such as reduced blood transfusion rates, shorter surgical times, less scarring, and shorter hospital stays.”

    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 [10]

    The Discussion describes avoiding prolonged operative times and hospital stays as potential benefits of minimally invasive surgery; the Perioperative Data report a median operation of 55.5 minutes, and the Discussion reports a median overnight stay of one night. The introduction describes shorter incisions than open approaches, but does not measure scarring. Reduced transfusion rates are not established: 50.2% of this series received transfusions, and the paper provides no open-surgery comparison. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Authors
Dalle Ore, C. L., Dilip, M., Brandel, M. G., McIntyre, J. K., Hoshide, R., Calayag, M., Gosman, A. A., Cohen, S. R., & Meltzer, H. S.
Affiliations
  • Department of Neurosurgery, University of California San Diego; and
  • University of California San Diego (US)
  • Divisions of Plastic Surgery and
  • Rady Children's Hospital-San Diego (US)
Corresponding author
Meltzer, Hal S.
ORCID
Venue
Journal of Neurosurgery: Pediatrics
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Published
2018-10
Volume
22
Issue
4
Pages
335-343
ISSN
  • 1933-0707 (ISSN-L)
  • 1933-0715
DOI
10.3171/2018.2.peds17364
OpenAlex
W2841701645
Cited by
39
References
45
Citations by year
2026: 3 · 2025: 10 · 2024: 8 · 2023: 3 · 2022: 8 · 2021: 3 · 2020: 1 · 2019: 2 · 2018: 1
FWCI
1.07
Type
journal article
Language
en
Open access
Locations
  • Journal of Neurosurgery Pediatrics (publishedVersion)
  • PubMed (publishedVersion)
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
nonsyndromic craniosynostosis, endoscopic craniosynostosis surgery, surgical complications, dural tear, subgaleal hematoma, conversion to open surgery, surgical site infection, postoperative ICU admission, length of hospital stay, intracranial hypertension, surgical planning, postoperative care
MeSH terms
Child, Craniosynostoses, Craniotomy, Humans, Infant, Retrospective Studies, Treatment Outcome, Plastic Surgery Procedures

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