Child's Nervous System

, Volume 34, Issue 9, pp 1627–1637 | Cite as

Endoscopic versus open approach in craniosynostosis repair: a systematic review and meta-analysis of perioperative outcomes

  • Anshit Goyal
  • Victor M. Lu
  • Yagiz U. Yolcu
  • Mohamed Elminawy
  • David J. DanielsEmail author
Review Paper



Surgery for craniosynostosis remains a crucial element in successful management. Intervention by both endoscopic and open approaches has been proven effective. Given the differences in timing and indications for these procedures, differences in perioperative outcomes have yet to be thoroughly compared between the two approaches. The aim of the systematic review and meta-analysis was to assess the available evidence of perioperative outcomes between the two approaches in order to better influence the management paradigm of craniosynostosis.


We followed recommended PRISMA guidelines for systematic reviews. Seven electronic databases were searched to identify all potentially relevant studies published from inception to February 2018 which were then screened against a set of selection criteria. Data were extracted and analyzed using meta-analysis of proportions.


Twelve studies satisfied all the selection criteria to be included, which described a pooled cohort involving 2064 craniosynostosis patients, with 965 (47%) and 1099 (53%) patients undergoing surgery by endoscopic and open approaches respectively. When compared to the open approach, it was found that the endoscopic approach conferred statistically significant reductions in blood loss (MD = 162.4 mL), operative time (MD = 112.38 min), length of stay (MD = 2.56 days), and rates of perioperative complications (OR = 0.58), reoperation (OR = 0.37) and transfusion (OR = 0.09), where all p < 0.001.


Both endoscopic and open approaches for the surgical management of craniosynostosis are viable considerations. The endoscopic approach confers a significant reduction in operative and postoperative morbidity when compared to the open approach. Given that specific indications for either approach should be considered when managing a patient, the difference in perioperative outcomes remain an important element of this paradigm. Future studies will validate the findings of this study and consider long-term outcomes, which will all contribute to rigor of craniosynostosis management.


Craniosynostosis Open Minimally invasive Endoscopic Microscopic Sagittal Metopic Complications 



Grading of Recommendations Assessment

Development and Evaluation


Newcastle-Ottawa Scale


Odds ratio


Relative risk


Mean difference


Standardized mean difference


Compliance with ethical standards

Conflict of interest

No funding sources or conflicts of interest to disclose.

Supplementary material

381_2018_3852_MOESM1_ESM.docx (79 kb)
Supplemental table 1 (DOCX 78.7 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Mayo Clinic Neuro-Informatics LaboratoryMayo ClinicRochesterUSA
  2. 2.Department of Neurologic SurgeryMayo ClinicRochesterUSA
  3. 3.Prince of Wales Clinical School, Faculty of MedicineUniversity of New South WalesSydneyAustralia

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