Spring-mediated cranioplasty versus endoscopic strip craniectomy for sagittal craniosynostosis

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  • 1 Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania;
  • | 2 Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts;
  • | 3 Drexel University, College of Medicine, Philadelphia;
  • | 4 Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia;
  • | 5 Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania;
  • | 6 Departments of Plastic and Oral Surgery and
  • | 7 Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts; and
  • | 8 Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Pennsylvania
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OBJECTIVE

Endoscopic strip craniectomy (ESC) and spring-mediated cranioplasty (SMC) are two minimally invasive techniques for treating sagittal craniosynostosis in early infancy. Data comparing the perioperative outcomes of these two techniques are sparse. Here, the authors hypothesized that outcomes would be similar between patients undergoing SMC and those undergoing ESC and conducted a study using the multicenter Pediatric Craniofacial Surgery Perioperative Registry (PCSPR).

METHODS

The PCSPR was queried for infants under the age of 6 months who had undergone SMC or ESC for sagittal synostosis. SMC patients were propensity score matched 1:2 with ESC patients on age and weight. Primary outcomes were transfusion-free hospital course, intensive care unit (ICU) admission, ICU length of stay (LOS), and hospital length of stay (HLOS). The authors also obtained data points regarding spring removal. Comparisons of outcomes between matched groups were performed with multivariable regression models.

RESULTS

The query returned data from 676 infants who had undergone procedures from June 2012 through September 2019, comprising 580 ESC infants from 32 centers and 96 SMC infants from 5 centers. Ninety-six SMC patients were matched to 192 ESC patients. There was no difference in transfusion-free hospital course between the two groups (adjusted odds ratio [aOR] 0.78, 95% CI 0.45–1.35). SMC patients were more likely to be admitted to the ICU (aOR 7.50, 95% CI 3.75–14.99) and had longer ICU LOSs (incident rate ratio [IRR] 1.42, 95% CI 1.37–1.48) and HLOSs (IRR 1.28, 95% CI 1.17–1.39).

CONCLUSIONS

In this multicenter study of ESC and SMC, the authors found similar transfusion-free hospital courses; however, SMC infants had longer ICU LOSs and HLOSs. A trial comparing longer-term outcomes in SMC versus ESC would further define the roles of these two approaches in the management of sagittal craniosynostosis.

ABBREVIATIONS

aOR = adjusted odds ratio; ASA = American Society of Anesthesiologists; BDE = blood donor exposure; CVR = cranial vault reconstruction; ESC = endoscopic strip craniectomy; HLOS = hospital length of stay; ICP = intracranial pressure; ICU = intensive care unit; IRB = institutional review board; IRR = incidence rate ratio; LOS = length of stay; PCCG = Pediatric Craniofacial Collaborative Group; PCSPR = Pediatric Craniofacial Surgery Perioperative Registry; RBC = red blood cell; SMC = spring-mediated cranioplasty; ZIP = zero-inflated Poisson.

Supplementary Materials

    • Supplemental Figs. 1 and 2 (PDF 2,824 KB)

Image from Mavridis et al. (pp 404–415).

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