Neurodevelopmental Outcomes Following Open and Endoscopic Repair of Isolated Sagittal, Coronal, Metopic, and Lambdoid Craniosynostosis

Background Craniosynostosis, characterized by premature fusion of cranial sutures, can impede childhood development. This study compares outcomes between open cranial vault remodeling and endoscopic strip craniectomy with helmet therapy in children with isolated craniosynostosis of the sagittal, metopic, coronal, and lambdoid sutures. Methods Retrospectively, 89 patients treated over 13 years were analyzed; 44 underwent endoscopic repair, and 45 underwent open surgery. Key operative variables including intraoperative blood loss, operative time, transfusion rates, and hospital stay were analyzed. Neurodevelopment was assessed at multiple postoperative intervals. Results The endoscopic group experienced significant perioperative advantages with lower mean intraoperative blood loss (58.84 mL vs. 107.61 mL, P < 0.001), reduced operative time (96 minutes vs. 244 minutes, P < 0.001), shorter hospital stays (2.67 days vs. 4.07 days, P < 0.001), and reduced opioid prescription rates (40.9% vs. 71.1%; P = 0.004) compared to the open group. Overall developmental delay rates were similar (29.3% vs. 20.9%, P = 0.378). However, those with isolated coronal synostosis (OR, 4.81, P = 0.057) and isolated metopic synostosis (OR, 16.73; P = 0.005) had increased odds of developmental delay compared to those with sagittal synostosis. Endoscopic intervention (OR, 11.32; P = 0.044), each additional month of age at surgery (OR, 1.25; P = 0.026), and drain placement (OR, 12.59; P = 0.018) were each independently and significantly associated with greater odds of delay. Conclusions Endoscopic repair may offer perioperative benefits yet may be an independent predictor of postoperative developmental delay alongside age and drain placement.