Endoscopic Versus Open Craniosynostosis Repair: A Comparative Middle Eastern Analysis of Surgical, Perioperative, and Morphometric Outcomes at the Largest Regional Craniofacial Center.

INTRODUCTION

Craniosynostosis correction can be performed through minimally invasive endoscopic suturectomy or traditional open cranial vault remodeling. While both achieve morphologic correction, comparative data on perioperative morbidity and cranial remodeling outcomes remain limited in regional centers. This study evaluates operative, perioperative, and morphometric outcomes following endoscopic versus open craniosynostosis repair at a tertiary neurosurgical institution.

METHODS

A retrospective cohort analysis was conducted on patients who underwent surgical correction for craniosynostosis between January 2021 and May 2025. Demographic, operative, and postoperative data were extracted from a prospectively maintained registry. Primary outcomes included operative time, estimated blood loss (EBL), length of hospital and ICU stay, and helmet therapy. Morphometric outcomes were assessed using the cephalic index (CI) and the cranial vault asymmetry index (CVAI). Statistical analysis was performed using IBM SPSS Statistics v23, with P<0.05 considered significant.

RESULTS

Twenty-seven patients were analyzed (endoscopic=16; open=11). The endoscopic cohort was younger (3.8±1.3 versus 17.5±8.9 mo; P<0.001) and demonstrated significantly reduced operative time (135 versus 240 min; P<0.001), EBL (90 versus 250 mL; P<0.001), hospital stay (3.4 versus 5.5 d; P<0.001), and ICU utilization (0% versus 100%; P<0.001). Both groups achieved significant cranial remodeling-CI improved from 0.75 to 0.78 (P=0.02) and CVAI from 4.8 to 1.5 (P<0.001). No major complications or reoperations occurred.

CONCLUSIONS

Endoscopic suturectomy performed early in infancy achieves equivalent morphologic correction with markedly reduced perioperative morbidity compared with open cranial vault remodeling. These findings support minimally invasive endoscopic repair as a safe, effective, and resource-efficient approach for early single-suture craniosynostosis.