1
|
Porto Junior S, Meira DA, da Cunha BLB, Fontes J, Pustilnik HN, da Silva da Paz MG, Araujo TB, Alcântara T, Dourado JC, de Avellar LM. Endoscopic surgery for craniosynostosis: A systematic review and single-arm meta analysis. Clin Neurol Neurosurg 2024; 242:108296. [PMID: 38749357 DOI: 10.1016/j.clineuro.2024.108296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Craniosynostosis, a developmental craniofacial anomaly, can impair brain development and cause abnormal skull shape due to premature closure of one or more cranial sutures. Traditional surgical treatments have evolved from open operations to minimally invasive endoscopic techniques. This systematic review and meta-analysis aim to evaluate the effectiveness and safety of the endoscopic approach in craniosynostosis correction. METHODS Adhering to Cochrane Group standards and the PRISMA framework, this review utilized databases like PubMed, Embase, and Web of Science, focusing on clinical and surgical outcomes of endoscopic craniosynostosis operations up to December 2023. Inclusion criteria emphasized studies with at least five patients undergoing endoscopic procedures, while exclusion criteria involved non-English papers, incomplete texts, and overlapping data. Statistical analysis used R software with various packages, and methodological bias was assessed using the ROBINS-I framework. RESULTS The review included 30 studies (4 prospective, 26 retrospective) with 2561 patients. The median age at operation was 3.20 months. Findings showed a mean operative time of 68.06 min, median hospital stay of 1.28 days, and mean blood loss of 29.89 ml. Blood transfusion was required in 9.97% of cases. Helmet therapy post-operation was common, with a median duration of 9 months. The rate of postoperative complications was 1.86%, and the reoperation rate was 3.07%. No procedure-related mortality was observed. The study noted substantial variations in the handling of craniosynostosis and a lack of consensus on the optimal timing and surgical approach. CONCLUSION Endoscopic techniques for craniosynostosis repair demonstrate safety and effectiveness, characterized by low complication risks and favorable surgical outcomes. However, due to the limitations of observational studies and inherent heterogeneity, further comprehensive and controlled trials are needed to validate these findings and understand the long-term outcomes of the endoscopic approach.
Collapse
Affiliation(s)
- Silvio Porto Junior
- Bahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Brotas, Salvador, Bahia, Brazil.
| | - Davi Amorim Meira
- Bahiana School of Medicine and Public Health, Dom João VI Avenue, 275, Brotas, Salvador, Bahia, Brazil
| | | | - Jefferson Fontes
- Metropolitan Union of Education and Culture, Luiz Tarquinio Pontes Avenue, 600, Fazenda Pitangueira, Lauro de Freitas, Bahia, Brazil
| | - Hugo Nunes Pustilnik
- University of Salvador, Dr. José Peroba Street, 251, Stiep, Salvador, Bahia, Brazil
| | - Matheus Gomes da Silva da Paz
- General Hospital Roberto Santos, Neurosurgery Department, Direta do Saboeiro Street, s/n, Cabula, Salvador, Bahia, Brazil
| | - Taiane Brito Araujo
- General Hospital Roberto Santos, Neurosurgery Department, Direta do Saboeiro Street, s/n, Cabula, Salvador, Bahia, Brazil
| | - Tancredo Alcântara
- General Hospital Roberto Santos, Neurosurgery Department, Direta do Saboeiro Street, s/n, Cabula, Salvador, Bahia, Brazil; NICC - Núcleo Integrado do Cérebro e Coluna, Pediatric Neurosurgery Department, Av. Juracy Magalhães Junior, 2096, Rio Vermelho, Salvador, Bahia, Brazil
| | - Jules Carlos Dourado
- General Hospital Roberto Santos, Neurosurgery Department, Direta do Saboeiro Street, s/n, Cabula, Salvador, Bahia, Brazil; NICC - Núcleo Integrado do Cérebro e Coluna, Neurosurgery Department, Av. Juracy Magalhães Junior, 2096, Rio Vermelho, Salvador, Bahia, Brazil
| | - Leonardo Miranda de Avellar
- General Hospital Roberto Santos, Neurosurgery Department, Direta do Saboeiro Street, s/n, Cabula, Salvador, Bahia, Brazil
| |
Collapse
|
2
|
Benaroch D, Brozynski M, Seyidova N, Oleru O, Agandi L, Abu El Hawa AA, Taub PJ. Nonsyndromic Craniosynostosis Correlation Between Ethnicity, Race, and Pattern of Affected Suture Type: Meta-Analysis. J Craniofac Surg 2024; 35:1402-1406. [PMID: 38819145 DOI: 10.1097/scs.0000000000010339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Previous studies have sought to analyze risk factors associated with craniosynostosis and while syndromic craniosynostosis is often linked to genetic mutations, the factors impacting nonsyndromic cases are less investigated. The aim of current meta-analysis is to evaluate the relationship between ethnicity and suture type in nonsyndromic craniosynostosis patients. METHODS The search term "craniosynostosis [Title/Abstract] AND (race [Title/Abstract] OR ethnicity [Title/Abstract])) NOT (syndrome [Title/Abstract])" was used to search the PubMed, Cochrane, and MEDLINE databases. Analyses were conducted separately for each racial and ethnic group for each suture type cohort. Odds ratios were conducted for each suture cohort and confounders were adjusted using linear mixed-effect models. Because of the homogeneity of the populations and categorical nature of the classification, binary logistic regression was run on aggregate data. RESULTS The literature search yielded 165 articles. After reviewing titles, abstracts, and manuscript contents of these articles, 5 studies were ultimately included in a meta-analysis. Studies with missing data for a particular cohort or variable were excluded from the respective analysis. Hispanic children had higher odds of sagittal suture involvement (OR: 1.53, P <0.001), whereas Asian had coronal suture (OR: 2.47, P <0.001). Both Asian and African American children had significantly lower odds of sagittal suture involvement (OR: 0.50, P <0.001 and OR: 0.7, P =0.04, respectively). CONCLUSION The relationship between ethnicity and craniosynostosis has been suggested as a risk factor, but without definitive conclusion. Present meta-analysis findings demonstrated association between ethnicity and suture type, however further research with larger scale and geographically varied data is warranted.
Collapse
Affiliation(s)
- David Benaroch
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
- American Medical Program at Tel Aviv University, New York, NY
| | - Martina Brozynski
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Olachi Oleru
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lorreen Agandi
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
- Touro College of Osteopathic Medicine, New York, NY
| | - Areeg A Abu El Hawa
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
3
|
Valenti AB, Munabi N, Obinero CG, Demetres M, Greives MR, Imahiyerobo TA. "Healthcare Disparities in the Care of Children with Craniosynostosis in the United States: A Systematic Review". Cleft Palate Craniofac J 2023:10556656231222318. [PMID: 38128929 DOI: 10.1177/10556656231222318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Healthcare inequity is a pressing concern in pediatric populations with craniofacial conditions. Little is known about the barriers to care affecting children with craniosynostosis. This systematic review investigates disparities impacting care for children with craniosynostosis in the U.S. METHODS A comprehensive literature search was performed in the following databases from inception to December 2022: Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies were screened for eligibility by two authors. All original articles that focused on disparities in access, treatment, or outcomes of craniosynostosis surgery were included. Studies describing disparities in other countries, those not written English, and review articles were excluded (Figure 1). RESULTS An initial database search revealed 607 citations of which 21 met inclusion criteria (Figure 1). All included studies were retrospective reviews of databases or cohorts of patients. The results of our study demonstrate that barriers to access in treatment for craniosynostosis disproportionally affect minority children, children of non-English speaking parents and those of lower socioeconomic status or with Medicaid. Black and Hispanic children, non-English speaking patients, and children without insurance or with Medicaid were more likely to present later for evaluation, ultimately undergoing surgery at an older age. These patients were also more likely to experience complications and require blood transfusions compared to their more privileged, white peers. CONCLUSIONS There is a discrepancy in treatment received by minority patients, patients with Medicaid, and those who are non-English speaking. Further research is needed to describe the specific barriers that prevent equitable care for these patients.
Collapse
Affiliation(s)
- Alyssa B Valenti
- Division of Plastic Surgery, New York Presbyterian Columbia Medical Center, New York, NY, USA
| | - Naikhoba Munabi
- Department of Plastic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Chioma G Obinero
- Division of Plastic and Reconstructive Surgery, McGovern Medical School at UT Health, Houston, TX, USA
| | | | - Matthew R Greives
- Division of Plastic and Reconstructive Surgery, McGovern Medical School at UT Health, Houston, TX, USA
| | - Thomas A Imahiyerobo
- Division of Plastic Surgery, New York Presbyterian Columbia Medical Center, New York, NY, USA
| |
Collapse
|
4
|
Rizvi I, Harrison LM, Parsa S, Hallac RR, Seaward JR, Kane AA. Open Versus Minimally Invasive Approach for Craniosynostosis: Analysis of the National Surgical Quality Improvement Program-Pediatric. Cleft Palate Craniofac J 2022:10556656221085478. [PMID: 35249396 DOI: 10.1177/10556656221085478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This multicenter study aimed to compare demographic, operative, and short-term outcomes data between open and minimally invasive surgical approaches for craniosynostosis repair utilizing the American College of Surgeon's National Surgical Quality Improvement Program Pediatric (NSQIP-P) database and highlight surgical disparities among races and ethnicities. DESIGN Retrospective review of large multicenter database. SETTING Freestanding general acute care children's hospitals, children's hospitals within a larger hospital, specialty children's hospitals, or general acute care hospitals with a pediatric wing. PATIENTS AND PARTICIPANTS A total of 4931 pediatric patients underwent craniosynostosis correction within the NSQIP-P database from 2013 to 2019. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Demographic information included age at surgery, sex, race, and ethnicity. Operative and outcomes measures included operative time, anesthesia time, days until discharge, postoperative complications, blood transfusions, 30-day readmission, and 30-day unplanned return to operating room. RESULTS Patients who underwent minimally invasive surgery had significantly shorter operative and anesthesia times (p < .001; p < .001), fewer days until discharge (p < .001), fewer postoperative complications (p < .05), and less blood transfusions (p < .001). The proportion of White patients was significantly higher in the minimally invasive surgery group (p < .01), whereas Black and Hispanic patients had a significantly higher proportion in the open surgery group (p < .001; p < .001). Additionally, the percentage of patients undergoing minimally invasive surgery increased from 3.8% in 2014 to over 13% in 2019. CONCLUSIONS This study adds to a growing consensus that minimally invasive surgery has significantly decreased operative time, anesthesia time, transfusion rates, length of hospital stay, and postoperative complications compared to open surgery. Racial and ethnic surgical disparities showed larger proportions of Black and Hispanic populations undergoing open procedures.
Collapse
Affiliation(s)
- Imran Rizvi
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lucas M Harrison
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shyon Parsa
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rami R Hallac
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James R Seaward
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alex A Kane
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
5
|
Suturectomies Assisted by Cranial Orthosis Remodeling for the Treatment of Craniosynostosis Can Be Performed Without an Endoscope. J Craniofac Surg 2021; 32:2774-2778. [PMID: 34727478 DOI: 10.1097/scs.0000000000007943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Minimally-invasive endoscopic strip-craniectomy (or suturectomy) for the repair of craniosynostosis combined with postoperative cranial orthotic molding has been widely adopted in the past 2 decades, proving itself as a safe and effective procedure. Over time the authors transitioned from performing an endoscopic strip-craniectomy, to performing the same surgery without the endoscope. The authors here describe our technique and compare its results to those published in the literature for endoscopic suturectomies. METHODS A retrospective chart review was performed for patients with nonsyndromic craniosynostosis who underwent minimally-invasive nonendoscopic suturectomy between 2019 and 2020 at our institution. RESULTS Thirteen patients (11 males; 2 females) were operated including 5 Metopic, 5 Sagittal, 2 coronal, and 1 lambdoid craniosynostosis. The average age at surgery was 4.35 months. The average length of surgery was 71 minutes. Averaged intraoperative estimated blood loss was 31.54 mL. Eleven patients received a blood transfusion (most before performing the skin incision) with a mean amount of 94.62 mL of blood transfused during surgery. The mean hemoglobin at discharge was 10.38 mg/dL. There was only 1 intraoperative mild complication. The mean intrahospital length of stay was 1.77 days with no postoperative complications noted. All patients initiated remodeling orthotic treatment following surgery. Long-term follow-up scans were available for 8 patients (5 metopic, 2 sagittal, and 1 lambdoid) with an average follow-up of 9 months. In all cases, there was a significant improvement in the skull width at the synostosis location as well as in the skull proportions and symmetry. The above outcomes are similar to those published in the literature for endoscope-assisted strip-craniectomies. CONCLUSIONS Suturectomies assisted with cranial orthosis remodeling for the treatment of all types of nonsyndromic craniosynostosis can be performed without an endoscope while maintaining minimal-invasiveness, good surgical results, and low complication rates.
Collapse
|
6
|
Hayward R. Editorial. Disparities in access to healthcare and the neurosurgeon. Neurosurg Focus 2021; 50:E14. [PMID: 33794494 DOI: 10.3171/2021.1.focus2124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
7
|
Discussion of Nationwide Perioperative Analysis of Endoscopic Versus Open Surgery for Craniosynostosis: Equal Access, Unequal Outcomes. J Craniofac Surg 2021; 32:154. [PMID: 33394633 DOI: 10.1097/scs.0000000000007322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|