A comparison of endoscopic strip craniectomy and pi craniectomy for treatment of sagittal craniosynostosis
Abstract
OBJECTIVE: Sagittal craniosynostosis is managed with a wide variety of operative strategies. The current investigation compares the clinical outcomes of two widely performed techniques: pi craniectomy and minimally invasive endoscopic strip craniectomy (ESC) followed by helmet therapy. METHODS: This IRB-approved retrospective study examined patients diagnosed with nonsyndromic, single-suture sagittal craniosynostosis treated with either pi craniectomy or ESC. Included patients had a minimum postoperative follow-up of 5 months. RESULTS: Fifty-one patients met the inclusion criteria (pi 21 patients, ESC 30 patients). Compared to patients who underwent ESC, the pi patients were older at the time of surgery (mean age 5.06 vs 3.11 months). The mean follow-up time was 23.2 months for ESC patients and 31.4 months for pi patients. Initial cranial index (CI) was similar between the groups, but postoperatively the ESC patients experienced a 12.3% mean increase in CI (from 0.685 to 0.767) compared to a 5.34% increase for the pi patients (from 0.684 to 0.719), and this difference was statistically significant (p < 0.001). Median hospital length of stay (1 vs 2 days) and operative duration (69.5 vs 93.3 minutes) were significantly less for ESC (p < 0.001 for both). The ESC patients showed a trend toward better results when surgery was done at younger ages. Craniectomy width in ESC cases was positively associated with CI improvement (slope of linear regression = 0.69, p = 0.026). CONCLUSIONS: While both techniques effectively treated sagittal craniosynostosis, ESC showed superior results compared to pi craniectomy. ESC showed a trend for better outcomes when done at younger ages, although the trend did not reach statistical significance. A wider craniectomy width (up to 2 cm) was associated with better outcomes than smaller craniectomy widths among the ESC patients.
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Magge et al. found no significant reduction in surgical burden with the Pi procedure compared to endoscopic craniectomy.
“Magge et al. noted no significant reduction in surgical burden compared to endoscopic craniectomy, though its long-term benefits remain debated [41].”
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 [41]
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- Authors
- Magge, S. N., Bartolozzi, A. R., Almeida, N. D., Tsering, D., Myseros, J. S., Oluigbo, C. O., Rogers, G. F., & Keating, R. F.
- Affiliations
- George Washington University (US)
- Stanford University (US)
- Divisions of Neurosurgery and
- Children's National (US)
- Venue
- Journal of Neurosurgery: Pediatrics
- Published
- 2019-06
- Volume
- 23
- Issue
- 6
- Pages
- 708-714
- ISSN
- 1933-0707 (ISSN-L)
- 1933-0715
- OpenAlex
- W2939389309
- Cited by
- 29
- References
- 32
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 6 · 2023: 5 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 1 · 2018: 2
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- closed
- 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
- sagittal craniosynostosis, endoscopic strip craniectomy, nonsyndromic craniosynostosis, helmet therapy, cranial index, timing of surgery, pediatric neurosurgery
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