ABSTRACT
Background: Craniosynostosis was a type of congenital cranial deformity resulted from premature fusion of one or more than one cranial sutures, which can cause abnormal symmetry of skull and neurological complications. Standard of care has been surgical correction with techniques evolving over the years to minimize risks and maximize functional and cosmetic results. It was critical that the long-term follow-up obviously not only look at short-term postoperative success, but success of cranial growth, neurocognitive development, and psychosocial adaptation.
Objective: To review the surgical techniques used for the management of craniosynostosis and to examine long-term outcomes regarding cranial shape, neurodevelopmental outcome, and complications associated with surgery.
Methods: This prospective study was carried out at Pakistan Institute of Medical Sciences (PIMS), Islamabad, from June 2024 to May 2025. This included a total of 110 craniosynostosis patients who had surgical correction. Patients were classified based on the type of synostosis and surgical approach (open cranial vault remodeling, strip craniectomy and endoscopic-assisted). Preoperative and follow-up clinical, radiological, and neurodevelopmental evaluations were performed at 3, 6, and 12 months. Systematic data from each trial and data regarding surgical duration, intraoperative hemorrhage, hospital stay, postoperative complications, and long-term cranial symmetry were reviewed.
Results: The majority of 110 patients had sagittal synostosis (42%), followed by coronal (31%), metopic (15%) and multiple-suture involvement (12%). Of the cases, 65% were open cranial vault remodeling, 20% were strip craniectomy, and 15% were endoscopic-assisted surgery. In the endoscopic-assisted group, the mean operative time and blood loss had been 2.5 times lower than nonars (Open surgery). There were reported postoperative complications of infection (6%), reoperation (4%) and minor wound-related problems (7%), no mortality had been observed. At long-term follow-up, good cranial symmetry was reached in 88% and good neurodevelopmental outcome in 81% of the patients (highest if treated before 1 year of age)
Conclusion: The study did show that early operative treatment for craniosynostosis yield good long-term results in cranial shape and neurodevelopment. Although endoscopic-assisted surgery had provided benefits in terms of less operative time, blood loss, and hospital stay; open cranial vault remodeling had remained the standard for more complex cases. It has all played an important role in making sure that a precise diagnosis, bespoke surgical correction and a long-term follow-up has been essential to achieving such dramatic improvements for these children and their families.
Keywords: Craniosynostosis, Surgical Techniques, Cranial Vault Remodeling, Endoscopic Surgery, Long-term Outcomes, Neurodevelopment.