School-age anthropometric and patient-reported outcomes after open or endoscopic repair of sagittal craniosynostosis
Annahita R. Fotouhi
Annahita R. FotouhiDepartment of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri;
Corinne M. MerrillDepartment of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri;
Suresh N. MaggeDivision of Neurosurgery, Children’s National Hospital, Washington, DC; Division of Neurosurgery, CHOC Neuroscience Institute, Children’s Hospital of Orange County, Orange, California; and Department of Neurosurgery, University of California, Irvine, California
Several studies have compared perioperative parameters and early postoperative morphology between endoscope-assisted strip craniectomy with orthotic therapy (endoscopic repair) and cranial vault remodeling (open repair). To extend these results, the authors evaluated school-age anthropometric outcomes after these techniques across three institutions.
开云体育世界杯赔率
School-aged children (age range 4–18 years) with previously corrected isolated sagittal craniosynostosis were enrolled. Upon inclusion, 3D photographs and patient-reported outcomes were obtained, and the cephalic index and head circumference z-scores were calculated. Analyses of covariance models controlling for baseline differences and a priori covariates were performed.
RESULTS
八十一名参与者(中位数(范围)(4 - 7岁5] years) were included. The mean (95% CI) school-age cephalic index was significantly higher in the endoscopic cohort, though within the normal range for both groups (endoscopic 78% [77%–79%] vs open 76% [74%–77%], p = 0.027). The mean change in the cephalic index from preoperation to school age was significantly greater in the endoscopic group (9% [7%–11%] vs open 3% [1%–5%], p < 0.001). Compared to preoperative measurements, mean school-age head circumference z-scores decreased significantly more in the open cohort (−1.6 [−2.2 to −1.0] vs endoscopic −0.3 [−0.8 to −0.2], p = 0.002). Patient-reported levels of stigma were within the normal limits for both groups.
CONCLUSIONS
Endoscopic and open repair techniques effectively normalize school-age anthropometric outcomes. However, endoscopic repair produces a clinically meaningful and significantly greater improvement in the school-age cephalic index, with maintenance of head growth. These findings demonstrate the importance of early referral by pediatricians and inform treatment decisions.
ABBREVIATIONS
CHOC = Children’s Hospital of Orange County;CNH = Children’s National Hospital;ICC = intraclass correlation coefficient;Neuro-QoL = Quality of Life in Neurological Disorders;SLCH = St. Louis Children’s Hospital.
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