Superior Outcomes in Endoscopic Strip Craniectomy Before Three Months of Age for Nonsyndromic Craniosynostosis

Introduction 

Management of all  craniosynostosis (CS) is primarily surgical, including both open calvarial vault remodeling (CVR) and endoscopic strip craniectomy (ESC).4 In ESC, the fused suture is excised, and barrel staves are created, both in minimally invasive fashion such that postoperative helmet, spring, or distractor device assistance allows for more gradual remodeling.5,6

 Currently, ESC is recommended for patients between 3 and 6 months of age given that rapid cranial growth and age-appropriate cranial malleability facilitate postoperative reshaping.6 However, increasing evidence suggests that surgery at even earlier ages may lead to faster deformity correction and reduced risk of neurological comorbidities.7,8 Although ESC has been successfully performed in children as young as 2 weeks of age,9 the literature supporting positive outcomes at operative ages younger than 3 months remains sparse.

Purpose

We sought to compare the perioperative and long-term outcomes of ESC performed for NSCS patients less than 3 months old vs. those for patients 3 months and older in order to assess the safety, efficacy, and potential advantages of providing earlier endoscopic intervention for NSCS management.

Methods