Craniometrics and Perioperative Variants in Non-Syndromic Single Suture Craniosynostosis with Cranial Vault Remodelling Surgery and Strip Craniotomy with and without Endoscopic Assistance: Systematic Review
Authors: Moustafa Hazem Ahmed , Ghany Walid Ahmed Abdel , Latif Assem Mounir Abdel , Elsabagh Abdelrahman Elsayed Mohammed 
Published: October 2021

Abstract

Background
Craniosynostosis is a major category in craniofacial anomalies defined as premature closure of one or more of cranial sutures. Diagnostic Indices and different measures and landmark points are being chosen according to age, the type of deformity and its severity, surgical procedure and targeted cosmetic outcome.

Objectives
Primary objective is to compare anthropometric measures Post-operative in short and long term follow up between different surgical modalities and impact on cosmetic outcome and need of second corrective surgical session. Secondary objective is to evaluate the Perioperative events between three surgical modalities in terms of Intra operative events; Estimated Blood Loss (EBL), rate of blood transfusion, Procedure duration and Post-operative events; Hospital Length of Stay, rate of post-operative complications and duration of needed Helmet therapy.

Methods and Material
The following electronic databases were searched from 2015 to 2019: PubMed, google scholar search engine. Cochrane database of systematic reviews, EMBASE for comparative studies between minimal invasive and open cranial vault remodelling techniques with different types of synostosis. Studies that were eligible if they contain the target keywords in title or abstract, addressing the age group up to 36 months with diagnosis of non- syndromic craniosynostosis by a plastic surgeon or neurosurgeon with or without confirmatory 3D skull reconstruction CT imaging. Follow-up outcomes were measured at 12 months or more. Exclusion criteria included studies lacking of quantitative comparison between open surgery and endoscopic assisted surgery, inclusion of patients with syndromic Craniosynostosis and editorials, abstracts and case reports.

Results
A total of 385 studies screened for eligibility, seven retrospective cohort studies were included in our systematic review for analysis of population demographics and management outcome with commenting of cosmetic outcome significance in comparison of different surgical modalities. Overall study population reaches 440 patients with different synostosis deformities with average age at surgery ranging from 2 to 6 months for endoscopic groups and 5 to 14 months for open surgery groups with average follow up duration reached 12 months. Analysis showed comparable postoperative cosmetic results between both techniques regardless type of synostosis with better perioperative outcomes such as less blood loss, shorter operations, shorter hospital stays and lower incidence of complications in minimal invasive and endoscopic assisted procedures groups.

Conclusions
We conclude that Minimal invasive approaches and especially endoscopic assisted craniotomies is a promising surgical option in craniosynostosis management. Regardless type of synostosis deformity, current literature comparing endoscopic and open CVR repair showed no statistical significant difference in craniometric analysis of cosmetic post-operative outcomes of both techniques. With improved perioperative outcomes, endoscopic assisted surgeries could be preferred for management team ideally for cases before 6 months age. Large population prospective studies and clinical trials are recommended for more high level evidence data for studying craniosynostosis management options for proper surgical decision making.