title: Microscopic versus open approach to craniosynostosis: a long-term outcomes comparison.
abstract: The purpose of this retrospective study was to evaluate the long-term outcomes of using the microscopic minimally invasive approach for the treatment of nonsyndromic craniosynostosis. During the last 10 years, 180 consecutive patients with nonsyndromic craniosynostosis were treated: 67 patients were treated with microscopic minimally invasive approach, and 113 were treated with the open approach. In the microscopic group, there was 1 intraoperative complication (1.5%). There were 10 postoperative complications (14.9%), of which 9 required major reoperations and 1 required a minor procedure. The major complications occurred in 7 unicoronal patients (58.3%) and 2 metopic patients (25.0%). In the open-approach group, there were 8 complications (7.1%), 2 patients required major reoperations and 6 required minor procedures. Chi-squared test showed that there was no statistically significant difference in the overall complication rate between the microscopic and open approaches. However, in the unicoronal patients, the complication rate was significantly higher in the microscopic group (P < 0.001). In conclusion, the microscopic approach is our treatment of choice in nonsyndromic patients with sagittal and lambdoidal craniosynostosis. We no longer use the microscopic approach in patients with unicoronal or metopic craniosynostosis because of the high complication rate.
authors.affiliation: From the *Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX; †Memorial Hermann Hospital, Houston, TX; ‡Medical School, The University of Texas Health Science Center at Houston, TX; §Department of Oral and Maxillofacial Surgery, Houston Methodist Hospital, Houston, TX; ∥Department of Surgery (Oral and Maxillofacial Surgery), Weill Medical College, Cornell University, New York, NY; and ¶Department of Orthodontics, The University of Texas Health Science Center at Houston, TX.
authors.forename: John F
authors.initials: JF
authors.lastname: Teichgraeber
authors.forename: James E
authors.initials: JE
authors.lastname: Baumgartner
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Viviano
authors.forename: Jaime
authors.initials: J
authors.lastname: Gateno
authors.forename: James J
authors.initials: JJ
authors.lastname: Xia
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies