Endoscopic strip craniectomy with molding helmet therapy versus spring-assisted cranioplasty for nonsyndromic single-suture sagittal craniosynostosis: a systematic review
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OBJECTIVE: Endoscopic strip craniectomy with postoperative molding helmet therapy (ESC-H) and spring-assisted cranioplasty (SAC) are commonly used minimally invasive techniques for correction of nonsyndromic sagittal craniosynostosis, but it is unclear which, if either, is superior. Therefore, the authors undertook a systematic review to compare ESC-H with SAC for the surgical management of nonsyndromic single-suture sagittal craniosynostosis. METHODS: Studies were identified through a systematic and comprehensive search of four databases (Embase, MEDLINE, and two databases in the Cochrane Library). Databases were searched from inception until February 19, 2021. Pediatric patients undergoing either ESC-H or SAC for the management of nonsyndromic single-suture sagittal craniosynostosis were included. Systematic reviews and meta-analyses, single-patient case reports, mixed cohorts of nonsyndromic and syndromic patients, mixed cohorts of different craniosynostosis types, and studies in which no outcomes of interest were reported were excluded. Outcomes of interest included reoperations, blood transfusion, complications, postoperative intensive care unit (ICU) admission, operative time, estimated blood loss, length of hospital stay, and cephalic index. Pooled summary cohort characteristics were calculated for each outcome of interest. Methodological quality was assessed using the Newcastle-Ottawa Scale. The study was reported in accordance with the 2020 PRISMA statement. RESULTS: Twenty-two studies were eligible for inclusion in the review, including 1094 patients, of whom 605 (55.3%) underwent ESC-H and 489 (44.7%) underwent SAC for nonsyndromic sagittal craniosynostosis. There was no difference between the pooled estimates of the ESC-H and SAC groups for operative time, length of stay, estimated blood loss, and cephalic index. There was no difference between the groups for reoperation rate and complication rate. However, ESC-H was associated with a higher blood transfusion rate and higher postoperative ICU admission. CONCLUSIONS: The available literature does not demonstrate superiority of either ESC-H or SAC, and outcomes are broadly similar for the treatment of nonsyndromic sagittal craniosynostosis. However, the evidence is limited by single-center retrospective studies with low methodological quality. There is a need for international multicenter randomized controlled trials comparing both techniques to gain definitive and generalizable data.
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Use of springs to treat prematurely fused sagittal suture allows two-dimensional expansion of the skull.
“The use of springs to treat prematurely fused sagittal suture, especially in cases where families refuse helmet therapy or the child is too old for it, allows two-dimensional expansion of the skull and has been shown to be a successful addition and minimally invasive alternative [51, 64].”
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 [51]
The Abstract and Cohort Characteristics sections describe spring-assisted cranioplasty as a treatment for sagittal craniosynostosis. The Cephalic Index section reports improvement after treatment, but the paper does not establish that springs produce two-dimensional skull expansion. Page numbers were unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredUse of springs to treat prematurely fused sagittal suture is a successful addition and minimally invasive alternative, especially when families refuse helmet therapy or the child is too old for it.
“The use of springs to treat prematurely fused sagittal suture, especially in cases where families refuse helmet therapy or the child is too old for it, allows two-dimensional expansion of the skull and has been shown to be a successful addition and minimally invasive alternative [51, 64].”
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 [51]
The Abstract identifies spring-assisted cranioplasty as a minimally invasive treatment for sagittal craniosynostosis, and the Cephalic Index section reports postoperative improvement. The Discussion notes that helmet therapy depends on compliance, but does not establish spring treatment specifically for families who refuse helmets or children too old for them. Our copy also does not describe two-dimensional expansion; the review cautions that its comparative findings are hypothesis-generating. (LLM, conf=0.86)
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References 30 · Cited by 23
Research works printed but not linked: 22
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- Authors
- Valetopoulou, A., Constantinides, M., Eccles, S., Ong, J., Hayward, R., Dunaway, D., Jeelani, N. U. O., James, G., & Silva, A. H. D.
- Affiliations
- Great Ormond Street Hospital (GB)
- Craniofacial Unit, Great Ormond Street Hospital for Children, London;
- ORCID
- Venue
- Journal of Neurosurgery: Pediatrics
- Published
- 2022-10-01
- Volume
- 30
- Issue
- 4
- Pages
- 455-462
- ISSN
- 1933-0707 (ISSN-L)
- 1933-0715
- OpenAlex
- W4293479602
- Cited by
- 23
- References
- 30
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 6 · 2023: 2
- FWCI
- 0.70
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Journal of Neurosurgery Pediatrics (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (17DS18)
- Great Ormond Street Hospital Charity (12SG15)
- Medical Research Council (MR/T005297/1)
- 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
- endoscopic strip craniectomy, blood transfusion, postoperative complications, reoperation, cephalic index, length of hospital stay, pediatric neurosurgery, surgical outcomes comparison
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