Is Endoscopic Treatment of Sagittal Craniosynostosis in Children Aged 6 to 9 Months an Effective Approach for Delayed Presentations?

Background Endoscopic approaches to sagittal craniosynostosis are typically used in children <6 months because of more predictable outcomes with postoperative helmet therapy. For children presenting at 6 months or older, surgeons usually opt for open repair for more predictable correction. Purpose The study's purpose was to estimate the incidence of satisfactory results and identify associated factors for children 6 months and older undergoing endoscopic-assisted craniectomy for sagittal craniosynostosis. Study design, setting, sample This retrospective cohort study included children who underwent endoscopic-assisted craniectomies for isolated, nonsyndromic sagittal craniosynostosis between 2018 and 2025 at UT Health San Antonio and El Paso Children's Hospital. Subjects who underwent a cranial vault reconstruction or prior surgery were excluded. Predictor variables Included age at surgery, preoperative cephalic index (CI), and time from surgery. Main outcome variables The primary outcome was achieving a satisfactory result, as defined by the surgery team for a CI measurement ≥70. Postoperative CI was categorized as excellent (≥75), good (70 to <75), or poor (<70). Secondary outcomes included absolute change in CI, changes in intracranial pressure (ICP), and adverse events. Covariates Included sex, head circumference, and craniectomy size. Analysis Bivariate analysis assessed associations between the satisfactory outcome, absolute change in CI, and the predictor variables. A paired sample t-test was used to compare changes in CI. Simple linear regression and analysis of variance were used to evaluate the relationship between age at surgery and CI changes. Results The sample included 14 subjects with a mean age of 7.56 (±1.1) months; 11 (78.6%) were male. Median follow-up was 15 months (interquartile range, 11 to 23). Satisfactory results were achieved in 12 children (85.7%). Age at surgery was negatively associated with satisfactory results (P = .005). No adverse events occurred. Among 7 (50%) children with available intraoperative ICP measurements, ICP decreased significantly following suture release (P = .012). Conclusions and relevance Endoscope-assisted release for sagittal craniosynostosis in children aged 6 to 9 months yields satisfactory results in most cases. Head growth velocity and bone thickness at this age did not appear to significantly impact outcomes. Endoscopic-assisted release should be considered for children in this age group presenting at centers with experienced craniofacial and orthotic teams.