Extended Minimal Invasive Craniectomy in Sagittal Synostosis – Is It Worth It?

Background Since 2017, we have been performing endoscopy assisted craniectomy for craniosynostosis, with approximately half of the 100 treated patients presenting with sagittal synostosis. Initially, only a narrow bone strip between the coronal and lambdoid sutures was removed. In 2022, we modified our approach by extending the craniectomy into the occiput, similar to our open technique. Aims The aim of this study was to evaluate the effect of this modification on perioperative and postoperative outcomes. Methods We analyzed all patients who underwent endoscopy assisted surgery for sagittal synostosis between 2017 and 2024, dividing them in two groups, according to surgical technique. We compared age and skull index at surgery, duration of surgery and hospital stay, blood loss and transfusion rate, as well as skull index at the and of the helmet therapy and one year later and duration of helmet therapy. Results Between 2017 and 2024, 50 children with sagittal synostosis underwent endoscopy assisted craniectomy. 45 had complete data for analysis. By mid-2022, 25 children underwent the previous technique, since then 20 patients the extended procedure. Age and initial skull index in the two groups did not differ significantly. At the end of the helmet therapy, the skull index was 2 points higher in the extended technique group and even 3 points higher 1 year later. The extension of the craniectomy increased the duration of surgery by 10 minutes, while there was no adverse effect on the duration of hospitalization, blood loss or need for transfusion. Conclusion Expanding the craniectomy improves the outcome after minimal invasive craniectomy in sagittal synostosis and should be considered at least in more severe cases, although a slightly longer duration of surgery has to be accepted.