299 Optimal Timing of Endoscopic Sagittal Suturectomy: Is Three Months Too Late?

INTRODUCTION: Endoscopic sagittal suturectomy (ESS) is commonly indicated for craniosynostois in infants, but optimal timing of surgery remains controversial with many clinicians only offering ESS before 3 months of age. METHODS: A single center retrospective review of patients with sagittal craniosynostosis that underwent ESS between 2009-2023 at Children’s National Medical Center was performed. Patients were stratified by age to compare outcomes and transfusion rates. Receiver operating curve (ROC) area under the curve (AUC) analysis identified optimal age cutoffs based on outcomes and transfusions. RESULTS: 107 patients were included. Stratifying age by 0-2 months, 2-3 months, and >3 months for analysis reveals the >3 months group was less likely to achieve target cephalic index (CI) at final follow up (48.8% v 61.5% v 25.0%, p = 0.031) and less mean percentage CI change at 6 month follow-up (17 ± 8% v 18 ± 8 % v 12 ± 6%, p = 0.011), at helmet discontinuation (18 ± 9% v 18 ± 8% v 12 ± 6%, p = 0.008), 1 year follow-up (15 ± 9% v 17 ± 7% v 10 ± 7%, p = 0.005), and final follow-up (14 ± 9% v 15 ± 7% v 8 ± 7%, p = 0.004). The only differences in CI outcomes between groups when stratified as 0-3 months versus >3 months is mean percentage change in CI at helmet removal (18 ± 8% versus 15 ± 7%, p = 0.044). CONCLUSIONS: The results of the study suggest patients over 3 months of age may still benefit from ESS for correction of isolated sagittal craniosynostosis. Further investigation with larger datasets is warranted to better identify the optimal age for surgical correction, and to investigate other variables influencing craniometric outcomes.