A Comparison of Endoscope-Assisted and Open Frontoorbital Distraction for the Treatment of Unicoronal Craniosynostosis.

BACKGROUND

Frontoorbital distraction osteogenesis (FODO) is an established surgical technique for patients with unicoronal craniosynostosis. The authors' institution has used an endoscope-assisted technique (endo-FODO) in recent years to decrease cutaneous scarring and lessen the impact on the functional growth matrix. This study compared perioperative outcomes in patients undergoing endo-FODO to those in patients undergoing the traditional coronal approach.

METHODS

Patients with unicoronal craniosynostosis undergoing FODO from 2013 to 2023 were included, and grouped by whether they underwent endo-FODO or a traditional coronal incision. Operative time, estimated blood loss, transfusion volume, and length of hospitalization were compared. Cutaneous scarring at 1 year postoperatively was assessed with the Scar Cosmesis Assessment and Rating (SCAR) scale.

RESULTS

A total of 27 patients (18 traditional and 9 endoscope-assisted) with an average age of 5.6 months (interquartile range [IQR], 5.1 to 6.3 months) at surgery were included, with no difference between groups (P = 0.999). Operative time was 114 minutes (IQR, 92 to 122 minutes) for traditional FODO and 104 minutes (IQR, 95 to 112 minutes) for endo-FODO (P = 0.607). Time under anesthesia was shorter for endo-FODO (traditional, 243 minutes [IQR, 218 to 264 minutes]; endo-FODO, 210 minutes [IQR, 191 to 224 minutes]; P = 0.029). Transfusion volume was 12.2 mL/kg lower for endo-FODO compared with traditional FODO (P = 0.001). Length of stay was similar between groups (P = 0.678). SCAR ratings were 1.83 (IQR, 1.1 to 4.47) in traditional FODO compared with 1.00 (IQR, 0.58 to 1.67) in the endo-FODO (P = 0.036).

CONCLUSIONS

Endo-FODO was associated with reduced time under anesthesia, reduced transfusion requirements, and improved SCAR scores, with no change in duration of surgery, perioperative complications, or length of stay. Future work will compare functional and aesthetic outcomes between techniques.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.