298 A Comparative Analysis of Surgical Techniques for Craniosynostosis: Open Surgery Versus Endoscopic Approach

INTRODUCTION: Craniosynostosis, the premature fusion of cranial sutures, poses significant challenges in pediatric neurosurgery due to its potential for cranial deformity and neurodevelopmental deficits. Surgical intervention, typically through either the open surgery (OS) or the minimally invasive endoscopic approach (EA), is necessary to address these complications. While OS involves extensive cranial remodeling, the EA offers a less invasive alternative. METHODS: Adhering to the PRISMA guidelines, a comprehensive search was performed on PubMed, Embase, and Cochrane. The outcomes of interest were surgical duration, blood transfusion, hospital/ICU stay, and postoperative cephalic index . Double-armed meta-analyses were performed using RevMan 5.4. The I2 test was employed for heterogeneity assessment, while ROBINS-I for the risk of bias. RESULTS: We included 33 studies (n=11,105 patients [8,266 OS; 2839 EA]). Our findings suggest that patients undergoing OS present with a higher risk ratio (RR)=4.38 (95%CI:2.37-8.10,p<0.00001) of receiving blood transfusion when compared to those undergoing EA. Additionally, the volume of blood transfused was higher in the OS group with a mean difference (MD)=210.2 mL (95%CI:177.07-243.32,p<00001). Lengths of ICU and hospital stay were also superior in the OS group, MD=1.82 days (95%CI:0.94-2.69,p=0.0001) and 2.70 days (95%CI:1.99-3.40,p<0.0001), respectively. Surgical time was longer in the OS group (MD=90.91 minutes [95%CI:86.43-95.38],p<0.00001). No difference on the MD of postoperative cephalic was seen. CONCLUSIONS: Patients undergoing OS are associated with higher risks and larger volumes of blood transfusion, when compared to those undergoing EA. Furthermore, the OS group experiences longer durations of both ICU and hospital stays, however, no statistically significant difference in postoperative cephalic index between the two techniques was seen. These findings highlight the clinical of adequately choosing surgical techniques, aiming for patients safety and optimizing recovery.