Purpose: The purpose of this study was to analyze the variations in surgical management of metopic synostosis including a critical review of the relative roles of endoscopic-assisted, minimally invasive and open approaches in the treatment of nonsyndromic metopic craniosynostosis. Three surgical procedures were primarily used in 35 patients treated from May 2002 to February 2006 at the Craniofacial Unit of Children's Hospital of San Diego: 1) Endoscopic-Assisted suturectomy; 2) Endoscopic assisted suturectomy with fronto-orbital advancement and cranial reconstruction and 3) Open frontal orbital advancement with cranial reconstruction.
Methods: Eighteen patients (mean age=4.5m; range=1m-8m) underwent endoscopic correction (ET). 17 patients (mean age=29m; range=3m-12y) underwent open correction (OT) with resorbable plate and screw fixation. Of the 18 ET patients, 9 (50%) had suturectomies alone, 5 (28%) had suturectomies with fronto-orbital advancement and cranial reconstruction, and 4 (22%) had suturectomies with cranial reconstruction.
Results: The ET group had less % blood loss [8.5% (ET); 21% (OT), p=0.007], lower transfusion rates [57% (ET); 70% (OT), p=0.016], shorter operative time [1.7 hrs (ET); 2.2 hrs (OT), p<0.001], shorter in-patient stay [2.5 days (ET); 2.8 days (OT), p=0.16], and less complications [one pinpoint dural tear (ET); 3 dural tears (OT), p=0.16]. 17 of 18 ET patients started helmet therapy within 2 weeks of surgery and wore 1-3 orthotic devices for 3-9 months. None of the ET and 3 of 17 OT patients (p=0.04) required secondary surgery.
Conclusions: A range of endoscopic and open techniques are available for the treatment of metopic craniosynostosis and can be customized to the individual patient's specific deformity and the age of presentation. After 3 years, patients having endoscopic-assisted or minimally invasive treatment, appear to have less overall morbidity and lower reoperation rates then patients undergoing the traditional open approach. Patient selection is critical to achieving good outcomes. Additional patient accrual and long term follow-up is required.