Bilateral coronal craniosynostosis in Apert syndrome is traditionally managed with open cranial vault remodeling procedures like fronto-orbital advancement (FOA). However, as minimally invasive procedures gain popularity, limited data exist to determine their efficacy in this syndromic population. This study examines whether endoscopic strip craniectomy (ESC) is inferior to FOA in correcting head growth in patients with Apert syndrome.
The authors conducted a retrospective review of children with Apert syndrome over a 23-year period. Postoperative head circumferences until 24 months of age were compared for patients treated with ESC versus FOA by using normative growth curves. Intraoperative and postoperative morbidity was compared between groups.
The median postoperative follow-up for the FOA (n = 14) and ESC (n = 16) groups was 40 and 28.5 months, the median age at operation was 12.8 and 2.7 months, and the median operative time was 285 and 65 minutes, respectively (p < 0.001). The FOA group had significantly higher rates of blood transfusion, ICU admission, and longer hospital length of stay (p < 0.01). There were no statistically significant differences in premature reossification rates, complications, need for further procedures, or complaints of asymmetry. Compared to normative growth curves, all patients in both groups had head circumferences comparable to or above the 85th percentile at last follow-up.
Children with Apert syndrome and bilateral coronal craniosynostosis treated with ESC experience early normalization of head growth and cephalic index that is not inferior to those treated with FOA. Longer-term assessments are needed to determine long-term aesthetic results and the correlation between head growth and neurocognitive development in this population.
BennettKG, HespeGE, VerclerCJ, BuchmanSR. Short- and long-term outcomes by procedure type for nonsagittal single-suture craniosynostosis. J Craniofac Surg. 2019;30(2):458–464.10.1097/SCS.0000000000005129)| false
HashmiA, CahillGL, ZaldanaM, Can head circumference be used as a proxy for intracranial volume in patients with craniosynostosis?Ann Plast Surg. 2019;82(5S Suppl 4):S295–S300.3097383510.1097/SAP.0000000000001803)| false
SpruijtB, JoostenKFM, DriessenC, Algorithm for the management of intracranial hypertension in children with syndromic craniosynostosis. Plast Reconstr Surg. 2015;136(2):331–340.10.1097/PRS.000000000000143425909300)| false
DiMaggioC, SunLS, LiG. Early childhood exposure to anesthesia and risk of developmental and behavioral disorders in a sibling birth cohort. Anesth Analg. 2011;113(5):1143–1151.10.1213/ANE.0b013e3182147f42)| false
McCannME, de GraaffJC, DorrisL, et al.Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. Lancet. 2019;393(10172):664–677.
McCannME, de GraaffJC, DorrisL, Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. Lancet. 2019;393(10172):664–677.10.1016/S0140-6736(18)32485-1)| false
SunLS, LiG, MillerTL, Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA. 2016;315(21):2312–2320.2727258210.1001/jama.2016.6967)| false
WarnerDO, ZaccarielloMJ, KatusicSK, et al.Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: the Mayo Anesthesia Safety in Kids (MASK) study. Anesthesiology. 2018;129(1):89–105.
WarnerDO, ZaccarielloMJ, KatusicSK, Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: the Mayo Anesthesia Safety in Kids (MASK) study. Anesthesiology. 2018;129(1):89–105.10.1097/ALN.000000000000223229672337)| false