A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture

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  • 1 Division of Neurosurgery, Department of Surgery, University of Toronto;
  • 2 Division of Neurosurgery, The Hospital for Sick Children, Toronto;
  • 3 Library and Information Services, University Health Network, University of Toronto, Ontario, Canada;
  • 4 Division of Neurosurgery, Nicklaus Children’s Hospital, University of Miami Miller School of Medicine, Miami, Florida;
  • 5 Division of Neurosurgery, CCHU-Ste-Justine Children’s, Montreal, Quebec, Canada;
  • 6 Department of Neurosurgery, Mattel Children’s Hospital, David Geffen School of Medicine at University of California Los Angeles, California; and
  • 7 Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
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OBJECTIVE

In this systematic review and meta-analysis the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of sagittal craniosynostosis, focusing on the outcomes of blood loss, transfusion rate, length of stay, operating time, complication rate, cost, and cosmetic outcome.

METHODS

A literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Effect estimates between groups were calculated as standardized mean differences with 95% CIs. Random and fixed effects models were used to estimate the overall effect.

RESULTS

Of 316 screened records, 10 met the inclusion criteria, of which 3 were included in the meta-analysis. These studies reported on 303 patients treated endoscopically and 385 patients treated with open surgery. Endoscopic surgery was associated with lower estimated blood loss (p < 0.001), shorter length of stay (p < 0.001), and shorter operating time (p < 0.001). From the literature review of the 10 studies, transfusion rates for endoscopic procedures were consistently lower, with significant differences in 4 of 6 studies; the cost was lower, with differences ranging from $11,603 to $31,744 in 3 of 3 studies; and the cosmetic outcomes were equivocal (p > 0.05) in 3 of 3 studies. Finally, endoscopic techniques demonstrated complication rates similar to or lower than those of open surgery in 8 of 8 studies.

CONCLUSIONS

Endoscopic procedures are associated with lower estimated blood loss, operating time, and days in hospital. Future long-term prospective registries may establish advantages with respect to complications and cost, with equivalent cosmetic outcomes. Larger studies evaluating patient- or parent-reported satisfaction and optimal timing of intervention as well as heterogeneity in outcomes are indicated.

ABBREVIATIONS EPHPP = Effective Public Health Practice Project; LOS = length of hospital stay; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SMD = standardized mean difference.

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Contributor Notes

Correspondence Han Yan: The Hospital for Sick Children, Toronto, ON, Canada. hhan.yan@mail.utoronto.ca.

INCLUDE WHEN CITING Published online July 6, 2018; DOI: 10.3171/2018.4.PEDS17729.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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