36. A Novel Endoscopic Modified H-plasty is Non-inferior to Open Cranial Vault Remodeling in Patients With Sagittal Craniosynostosis Who Present Outside the Window of Eligibility for Endoscopic Strip Craniectomy

PURPOSE: Previous literature has demonstrated improved perioperative outcomes with the use of endoscopic strip craniectomy (endo strip) as compared to open cranial vault remodeling (open H) for the treatment of sagittal craniosynostosis. Unfortunately, patients who present after 5-to-6 months of age are generally ineligible for endoscopic treatment. Herein, we describe our experience employing a novel endoscopic modified H-plasty (endo H) approach for sagittal synostosis. METHODS: The records of patients who underwent endoscopic strip craniectomy, open H-plasty, and endoscopic H-plasty were reviewed, and demographic as well as perioperative outcomes were compared. Our method involves 2 cm long incisions, one just posterior to the bregma and another just anterior to the lambda with dissection to the subgaleal plane. An endoscope is used to remove two parasagittal bone strips and bilateral coronal and lambdoid sutures. The skull is shortened by removal of a small segment secured to the frontal bone. Analysis was conducted via descriptive statistics, chi-squared testing, ANOVA, and Tukey’s HSD post hoc analysis. RESULTS: A total of 133 patients were included (58 open H, 44 endo strip, 31 endo H). There was no significant difference in age at reconstruction between groups, with the endo H group undergoing surgery at an average of 6.9 ± 11.79 months. The endo strip group had a significantly shorter operative duration and length of hospitalization than both the open H and endo H groups (p<.05). There was no significant difference in blood loss between the endo strip and endo H groups (p=.14). Three patients in the endo H group (9.7%) underwent minor scar revisions, but there were no other complications or revisions associated with this approach. CONCLUSION: Our endoscopic modified H-plasty approach offers a non-inferior alternative to open cranial vault remodeling that negates the need for a bicoronal incision in patients who present outside the window of eligibility for traditional endoscopic strip craniectomy.