| Presenter: Dennis Nguyen, MD, MS, Washington University School of Medicine
Authors: Dennis Nguyen (1), Andrew H. Huang (2), Kamlesh Patel (3), Gary Skolnick (1), Sybill Naidoo (1), Matthew Smyth (4), Albert Woo (1)
(1) Washington University School of Medicine, St. Louis, MO, (2) Washington University in St. Louis, Saint Louis, MO, (3) Washington University in St. Louis, St. Louis, MO, (4) Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO
Dennis Nguyen, MD, MS
Washington University School of Medicine
Patients with metopic craniosynostosis with associated hypotelorism and trigonocephaly are classically treated with fronto-orbital advancement. A less-invasive endoscopic treatment comprises narrow ostectomy of the fused suture followed by post-operative helmet molding. Here we compare the one-year post-operative results of our open versus endoscopically-treated patients in terms of their associated deformities.
We reviewed pre-operative and one-year post-operative 3D reconstructed computed tomography scans of patients treated for non-syndromic metopic craniosynostosis by either open (n=15) or endoscopic (n=13) technique. Hypotelorism was assessed by interzygomaticofrontal distance (ZFD) and intercanthal distance (ID). Trigonocephaly was assessed by two independent angles: first, an axial-plane two-dimensional angle between frontotemporale bilaterally and the glabella (FTG); second, an interfrontal angle (IFA) between the most anterior point from a reconstructed midsagittal plane and supraorbital notch bilaterally. All images were oriented to the sella-nasion horizontal. Age-matched scans of unaffected patients (n=28) served as controls for each case.
Patients with open repair (9.5±1.8 months) were older at time of surgery than patients with endoscopic repairs (3.3±0.4 months) (p=0.004). Male to female ratios were equivalent at roughly 7:3 in both groups. Preoperatively, the endoscopic group had more severe hypotelorism and FTG than the open group (p<=0.04). After accounting for pre-operative differences, all of the postoperative measurements of the two groups were statistically equivalent (p ? 0.38) except for ZFD (p = 0.005). Trigonocephaly was significantly improved post repair in both the open (8° (FTG) and 18° (IFA)) and endoscopic (13° (FTG) and 16° (IFA)) groups (p < 0.001). Postoperative measures in both groups were equivalent to controls (0.08 < p < 0.98). Intra-rater reliability ranged from 0.93 to 0.99 for all measurements.
Our retrospective series shows that endoscopic and open repair of metopic craniosynostosis are equivalent in normalizing hypotelorism and trigonocephaly at one year followup. In this small sample ZFD was greater post-endoscopic compared to open repair. Additional studies are necessary to better define minor differences in morphology which may result from the different techniques.