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Outcomes After Endoscopic-assisted Repair For Syndromic Craniosynostosis
Sarah N. Chiang, BS, Gary B. Skolnick, MBA, Sybill D. Naidoo, PhD, RN, CPNP, Matthew D. Smyth, MD, Kamlesh B. Patel, MD, MSc.
Washington University School of Medicine, St. Louis, MO, USA.

PURPOSE:
Endoscopic craniosynostosis repair has emerged as an effective alternative to open repair, but data are limited on treatment of the 15-24% of patients with syndromic diagnoses. Here, we examine postoperative outcomes after endoscopic repair in syndromic craniosynostosis.
METHODS:
Retrospective review was performed of all consecutive patients undergoing endoscopic repair and all syndromic patients undergoing open repair from 2006-2021. Demographics, complications, and reoperations were compared between groups. Patient-reported measures of stigma and cognitive function were recorded at age 5 years and greater.
RESULTS:
335 patients underwent endoscopic repair, of which 38 (11%) had syndromic craniosynostosis. Syndromic craniosynostosis was associated with bicoronal involvement (p<0.001) and female sex (p=0.003). Secondary procedures were significantly more common in the syndromic group (24% vs 2.4%, p<0.001), as were transfusions (18% vs 6.4%, p=0.018). Secondary procedures were performed at a mean 2.8 years of age (range 10 months to 8 years), and most commonly consisted of fronto-orbital advancement (7 in syndromic group, 3 in non-syndromic). Patient-reported stigma was higher in patients with syndromes (p=0.002), but cognitive function did not differ significantly (p=0.065). Incidence of reoperations after open repair was 13%, but baseline differences precluded direct comparison with the endoscopic group.
CONCLUSION:
Minimally invasive approaches in early infancy can alleviate the need for additional cranial procedures in the growing child. Syndromic craniosynostoses are a complex and heterogeneous group, and in more severe cases, endoscopic repair can be considered an adjunct technique to reduce the number of major craniofacial procedures.

Outcomes of patients undergoing endoscopic craniosynostosis repair.
Non-syndromic (n=297)Syndromic (n=38)p-value
Anesthesia time, minutes (IQR)133 (119, 157)167 (131, 186)<0.001
Estimated blood loss, mL (IQR)25 (20, 30)30 (20, 40)0.079
Length of stay, days (IQR)1 (1, 1)1 (1, 1)0.049
Reoperation, n (%)7 (2.4)9 (24)<0.001
Transfusion, n (%)19 (6.4)7 (18)0.018
Complication, n (%)17 (5.7)4 (11)0.28
Neuro-QOL Stigma (IQR)35.5 (35.5, 40.7)47.7 (42.4, 54.1)0.002
PROMIS Cognitive function52.5 9.945.5 7.60.065


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