Comparative Outcomes of Fronto-Orbital Advancement and Strip Craniectomy in the Management of Metopic Craniosynostosis

OBJECTIVE: Metopic craniosynostosis results in characteristic trigonocephaly and may impair cranial growth. Surgical correction is traditionally performed using fronto-orbital advancement (FOAR), while strip craniectomy with postoperative helmet therapy (SC) has emerged as a minimally invasive alternative. This study compares perioperative outcomes and postoperative cranial shape between FOAR and SC. METHODS: A retrospective cohort study was conducted at a tertiary pediatric craniofacial unit. Patients with isolated metopic craniosynostosis treated with FOAR or SC between 2015 and 2024 were included. Primary outcomes were operative time, blood transfusion volume, hospital stay, and complication rates. Postoperative cranial morphology was assessed using two-dimensional photograph-derived craniometrics, including the anterior arc angle (AAA). RESULTS: Thirty-six patients were included (FOAR n=18, SC n=18). SC was associated with significantly shorter operative time (83.8±29.2 versus 177.6±31.6 min), shorter hospital stay (1.28±0.46 versus 4.22±0.55 d), and lower transfusion volume (10.1±10.9 versus 33.0±13.8 mL/kg) (all P<0.0001). Total complication rates were 11 percent for SC and 27.8 percent for FOAR. Among patients with available images (n=20), both cohorts showed significant postoperative AAA improvement, without a statistically significant difference between groups. CONCLUSION: Strip craniectomy with helmet therapy is a safe and effective alternative to FOAR for appropriately selected infants, offering reduced perioperative morbidity and cost while achieving significant short-term improvement in frontal cranial morphology.