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Cited by 64Craniofacial Disorders and TreatmentsPectus Deformity Diagnosis and TreatmentReconstructive Facial Surgery Techniques

Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling

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Isaac, Kathryn V., Meara, John G., Proctor, Mark R.·2018·Journal of Neurosurgery: Pediatrics
DOI 10.3171/2018.5.peds1846
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Abstract

OBJECTIVE: Comparative effectiveness studies are needed for analyzing the clinical outcomes of treatment of sagittal craniosynostosis (SC) with endoscopic suturectomy (ES) or cranial vault remodeling (CVR). METHODS: From 2004–2015, patients were consecutively reviewed and data recorded for operative details and complications. Cranial growth was measured by head circumference percentile (HCP) and cranial index (CI) Z-score. Aesthetic outcomes were compared using the Whitaker classification. RESULTS: A total of 207 patients with nonsyndromic SC were treated with ES (n = 187) or CVR (n = 20). The ES group had a lower median operative duration (45 vs 195 minutes), length of stay (1 vs 3 days), and transfusion rate (2% vs 85%; p < 0.0001). Median age at follow-up was 3.0 years (interquartile range [IQR] 2.5–4.5, ES) and 3.9 years (IQR 2–5, CVR; p = 0.12). In both groups, HCP gradually decreased during a 3-year follow-up (p = 0.282). CI Z-scores were initially more favorable in the ES group (p < 0.05); 3 years following surgical intervention, Z-scores were equal between groups (p = 0.392). One nonsyndromic patient treated with ES (0.5%) demonstrated reossification and required secondary expansion. Most patients were Whitaker class I (99% of ES, 95% of CVR); 5% of CVR patients were class II and 1% of ES patients were class III. Four syndromic patients presented without clear evidence of a syndrome, were treated by ES, and subsequently required secondary expansion for raised intracranial pressure. CONCLUSIONS: ES is an effective treatment for nonsyndromic SC with comparable head growth, aesthetic outcomes, and less morbidity relative to CVR. In the absence of a syndrome, secondary cranial expansion following ES is rarely required.

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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 [11]

    The Perioperative Data section reports significantly lower blood loss and operative time for endoscopic suturectomy than for cranial vault remodeling. The Operative Technique section describes two 2-cm incisions and postoperative helmeting, but the paper does not establish that scarring is minimal. Page numbers are not available in our copy. (LLM, conf=0.88)

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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 [11]

    The Operative Technique section (page not supplied) describes cranial vault remodeling as correcting the deformity during surgery, without postoperative helmeting. Perioperative Data (page not supplied) reports significantly greater blood loss with remodeling than with endoscopic suturectomy. The paper does not establish a higher risk of scarring, so that part of the claim is unsupported. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The surgical management of sagittal synostosis has evolved significantly, shifting from early procedures like the Pi technique towards more comprehensive approaches such as CVR and SC.

    “The surgical management of sagittal synostosis has since evolved significantly, shifting from early procedures like the Pi technique towards more comprehensive approaches such as CVR and SC [1, 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 [11]

    The Abstract says surgical techniques have evolved and identifies CVR and endoscopic suturectomy (ES) as treatments. The Methods describe ES being introduced alongside CVR at the authors’ institution in 2004. Our copy does not describe a shift from the Pi technique, and it uses SC to mean sagittal craniosynostosis, not a surgical approach. (LLM, conf=0.85)

    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 [11]

    The Operative Technique section describes more extensive bone remodeling for open cranial vault remodeling, and Perioperative Data report significantly greater estimated blood loss than with endoscopic suturectomy. The Aesthetics section says bony skull defects are uncommon with either procedure; it does not establish that open surgery causes larger defects. The paper also does not establish more pronounced scarring or characterize blood loss as a common intra- and postoperative complication. Page numbers were not supplied in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Several studies have shown the efficacy of endoscopic treatment of ISS and comparable results to those after open cranial remodelling.

    “Several studies have shown the efficacy of endoscopic treatment of ISS and comparable results to those after open cranial remodelling [71,72,73].”

    From Isolated Sagittal Craniosynostosis: A Comprehensive Review (2024) · cites this paper as [73]

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Authors
Isaac, K. V., Meara, J. G., & Proctor, M. R.
Affiliations
Boston Children's Hospital (US)
Corresponding author
Isaac, Kathryn V.
ORCID
Venue
Journal of Neurosurgery: Pediatrics
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Published
2018-11
Volume
22
Issue
5
Pages
467-474
ISSN
  • 1933-0707 (ISSN-L)
  • 1933-0715
DOI
10.3171/2018.5.peds1846
OpenAlex
W2885762371
Cited by
64
References
45
Citations by year
2026: 5 · 2025: 10 · 2024: 8 · 2023: 10 · 2022: 13 · 2021: 10 · 2020: 6 · 2019: 2
FWCI
2.75
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 › Surgery › Reconstructive Facial Surgery Techniques
Keywords
sagittal craniosynostosis, cranial vault remodeling, nonsyndromic craniosynostosis, syndromic craniosynostosis, head circumference growth, cranial index, cosmetic outcome, reossification, intracranial pressure, surgical complications, operative time
MeSH terms
Child, Preschool, Cranial Sutures, Craniosynostoses, Endoscopy, Female, Humans, Infant, Male, Skull, Treatment Outcome, Plastic Surgery Procedures

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