A comparative analysis of suturectomy versus remodeling in non-syndromic craniosynostosis: A systematic review and meta-analysis

Non-syndromic craniosynostosis, involving premature fusion of isolated cranial sutures, is managed surgically by either minimally invasive strip suturectomy or open cranial vault remodeling. Although individual cohort studies have described perioperative metrics and cranial index improvements for each technique, no meta-analysis has systematically compared their relative efficacy, safety, and morphologic impact across different suture types, leaving optimal procedural selection unresolved. This meta-analysis evaluates postoperative outcomes and complications of suturectomy versus cranial remodeling in pediatric patients with non-syndromic craniosynostosis. Systematic searches of ScienceDirect, MEDLINE, Embase, and CENTRAL databases identified cohort studies up to October 2024 (PROSPERO ID: CRD42024606734). Postoperative outcomes included cephalic index (CI), interfrontal angle (IFA), interzygomaticofrontal distance (IZFD), and complications. Intraoperative outcomes encompassed operation time, estimated blood loss, hospital stay, revision surgeries, and transfusion requirements. This meta-analysis included 25 cohort studies with 3344 children (mean age 8.10 ± 3.34 months), divided into the suturectomy group (1424 children) and the remodeling group (2099 children). The suturectomy group showed significant advantages: shorter operation time (MD:-143.18; 95 %CI:- 180.06 to −106.29; p < 0.001), reduced estimated blood loss (MD:-221.17; 95 %CI:-305.41 to −136.90; p < 0.001), shorter hospital stay (MD:-2.58; 95 %CI:-3.07 to −2.09; p < 0.001), lower revision surgeries (RR:0.31; 95 %CI:0.13–0.72; p = 0.01), decreased blood transfusion (RR:0.01; 95 %CI:0.00–0.05; p < 0.001), and fewer complications (RR:0.28; 95 %CI:0.09–0.89; p = 0.03). In the suturectomy group, CI (MD:0.06; 95 %CI:0.03–0.08; p < 0.001) and IFA (MD:12.05; 95 %CI:6.62–17.47; p < 0.001) improved significantly, while IZFD did not. In the remodeling group, CI (MD:0.05; 95 %CI:0.02–0.08; p < 0.001) and IFA (MD:13.47; 95 %CI:9.58–17.91; p < 0.001) also improved, but IZFD showed no significant change. Cranial indices were not significantly different between both groups. Suturectomy offers better intraoperative outcomes, with reduced operative time, blood loss, hospital stay, revision surgeries, blood transfusion, and complications, making it ideal for younger, single-suture cases. Cranial indices were found to be similar following both interventions. • Suturectomy offers shorter operative time and hospital stay than remodeling. • Reduced blood loss and transfusion needs favor suturectomy for younger patients. • Complications are fewer with suturectomy, including revision surgeries. • Both suturectomy and remodeling improve cranial indices significantly. • Cranial indices post-surgery are comparable between the two procedures.