SO15. Equivalent Neurodevelopmental Outcomes Between Patients With Sagittal Craniosynostosis Treated With Endoscopic Strip Craniectomy and Open Calvarial Vault Remodeling

PURPOSE: We aimed to compare prospective neurocognitive testing and long-term outcomes of sagittal-craniosynostosis (SCS) patients treated with endoscopic strip-craniectomy (ESC) versus calvarial-vault remodeling (CVR), at a single institution. METHODS: Non-syndromic SCS patients >3 years old, who underwent ESC with post-operative helmeting or CVR at a single institution, were included. Prospective cognitive testing was offered for patients >6 years, comprising a double-blinded neurodevelopmental battery: Wechsler-Abbreviated-Scale (performance, verbal, full-scale IQ) and Beery-Buktenica test (visuomotor, visual-perception, motor-coordination). RESULTS: Ninety SCS patients were identified, 33 ESC and 57 CVR. CVR patients were older at surgery (mean 10.1 vs 2.6 month; p<0.001), with higher estimated blood loss (22.9 vs 8.2 mL/kg; p<0.001), and intraoperative transfusions (17.2 vs 8.1 mL/kg; p<0.001). At mean follow up 3.7 years, there were no differences in reoperation-rate (12.3% CVR and 3.1% ESC), neuro-developmental (13.2% CVR vs 9.7% ESC) or psychiatric diagnoses (3.6% CVR, 0% ESC). Fifteen patients completed neurocognitive testing, 7 ESC and 8 CVR, without difference in testing age (7.5yrs CVR, 6.7yrs ESC). ESC had longer gestational age (39 vs 36 weeks; p=0.046), higher maternal(p=0.005) and paternal education(p=0.001), and higher incomes(p=0.003). ESC achieved better performance IQ (115 vs 93; p=0.027), visuomotor scores (102 vs 92; p=0.027), and visual perception (116 vs 99; p=0.014). When controlling for demographic factors that significantly correlated with outcomes (ethnicity, maternal age, maternal/paternal education, household-income), there were no differences in neurodevelopment. CONCLUSION: Patients receiving ESC or CVR for SCS at a single institution have similar prospective and longitudinal neurodevelopmental outcomes when controlling for demographic differences.