A systematic review of endoscopic versus open treatment of craniosynostosis. Part 2: the nonsagittal single sutures

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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

Despite increasing adoption of endoscopic techniques for repair of nonsagittal single-suture craniosynostosis, the efficacy and safety of the procedure relative to established open approaches are unknown. In this systematic review the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of metopic, unilateral coronal, and lambdoid craniosynostosis, with an emphasis on quantitative reported outcomes.

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 (EPHPP) Quality Assessment Tool for Quantitative Studies.

RESULTS

Of 316 screened records, 7 studies were included in a qualitative synthesis of the evidence, of which none were eligible for meta-analysis. These reported on 111 unique patients with metopic, 65 with unilateral coronal, and 12 with lambdoid craniosynostosis. For all suture types, 100 (53%) children underwent endoscope-assisted craniosynostosis surgery and 32 (47%) patients underwent open repair. These studies all suggest that blood loss, transfusion rate, operating time, and length of hospital stay were superior for endoscopically treated children. Although potentially comparable or better cosmetic outcomes are reported, the paucity of evidence and considerable variability in outcomes preclude meaningful conclusions.

CONCLUSIONS

Limited data comparing open and endoscopic treatments for metopic, unilateral coronal, and lambdoid synostosis suggest a benefit for endoscopic techniques with respect to blood loss, transfusion, length of stay, and operating time. This report highlights shortcomings in evidence and gaps in knowledge regarding endoscopic repair of nonsagittal single-suture craniosynostosis, emphasizing the need for further matched-control studies.

ABBREVIATIONS EBL = estimated blood loss; EPHPP = Effective Public Health Practice Project; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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Contributor Notes

Correspondence Taylor J. Abel: The Hospital for Sick Children, Toronto, ON, Canada. taylor.abel@sickkids.ca.

INCLUDE WHEN CITING Published online July 6, 2018; DOI: 10.3171/2018.4.PEDS17730.

H.Y. and T.J.A. contributed equally to this work.

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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