Endoscope-assisted versus open repair of craniosynostosis:  a comparison of perioperative cost and risk.
BACKGROUND
Craniosynostosis, the premature closure of calvarial sutures, results in characteristic skull deformations. Correction of craniosynostosis has traditionally involved an open cranial vault remodeling procedure. A technique recently developed uses an endoscope to perform a strip craniectomy in conjunction with a postoperative molding helmet to guide cranial growth. Few studies compare these 2 approaches to the treatment of the various forms of craniosynostosis. In this study, we present a single institution's experience with open cranial vault remodeling and endoscope-assisted strip craniectomy.


METHODS
This study is a retrospective review of 57 patients that underwent craniosynostosis repair by either the endoscope-assisted or open techniques, and compared operating room times, blood loss, volume of transfused blood, length of hospital stay, and overall costs.


RESULTS
The endoscopic technique is performed on younger children (4.7 months vs 10.6 months, P = 0.001), has shorter operating room times (2 hours 13 minutes vs 5 hours 42 minutes, P = 0.001), lower estimated blood loss (74.4 mL vs 280.2 mL, P = 0.001), less transfused blood (90.6 mL vs 226.9 mL), shorter hospital stays (1.2 days vs 4.9 days, P = 0.001), and decreased cost ($24,404 vs $42,744, P = 0.008) relative to the traditional open approach.


CONCLUSIONS
Issues with the endoscope-assisted procedure primarily concerned the postoperative helmet regimen, specifically patient compliance (17.1% noncompliance rate) and minor skin breakdown (5.7%). The endoscope-assisted repair with postoperative helmet molding therapy is a cost-effective procedure with less operative risk and minimal postoperative morbidity. This is a valuable treatment option in younger patients with compliant caregivers.
Division of Plastic and Reconstructive Surgery, Tulane Health Sciences Center, Louisiana State University School of Medicine, Division of Plasticand Reconstructive Surgery, 1542 Tulane Ave Room 758A, New Orleans, LA 70112, USA.
Jennifer W H
JW
Chan
Camille L
CL
Stewart
Mark W
MW
Stalder
Hugo
H
St Hilaire
Lori
L
McBride
Michael H
MH
Moses
D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003398:Craniosynostoses / Q000191:economics* / Q000601:surgery*; D004724:Endoscopy / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome