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Endoscopic strip craniectomy with molding helmet therapy versus spring-assisted cranioplasty for nonsyndromic single-suture sagittal craniosynostosis: a systematic review
Journal of Neurosurgery: Pediatrics ( IF 2.713 ) Pub Date : 2022-08-05 , DOI: 10.3171/2022.7.peds2232
Alexandra Valetopoulou 1 , Maria Constantinides 1 , Simon Eccles 1 , Juling Ong 1, 2 , Richard Hayward 1, 2, 3 , David Dunaway 1, 2 , Noor Ul Owase Jeelani 1, 2, 3 , Greg James 1, 2, 3 , Adikarige Haritha Dulanka Silva 1, 3
Affiliation  

OBJECTIVE

Endoscopic strip craniectomy with postoperative molding helmet therapy (ESC-H) and spring-assisted cranioplasty (SAC) are commonly used minimally invasive techniques for correction of nonsyndromic sagittal craniosynostosis, but it is unclear which, if either, is superior. Therefore, the authors undertook a systematic review to compare ESC-H with SAC for the surgical management of nonsyndromic single-suture sagittal craniosynostosis.

METHODS

Studies were identified through a systematic and comprehensive search of four databases (Embase, MEDLINE, and two databases in the Cochrane Library). Databases were searched from inception until February 19, 2021. Pediatric patients undergoing either ESC-H or SAC for the management of nonsyndromic single-suture sagittal craniosynostosis were included. Systematic reviews and meta-analyses, single-patient case reports, mixed cohorts of nonsyndromic and syndromic patients, mixed cohorts of different craniosynostosis types, and studies in which no outcomes of interest were reported were excluded. Outcomes of interest included reoperations, blood transfusion, complications, postoperative intensive care unit (ICU) admission, operative time, estimated blood loss, length of hospital stay, and cephalic index. Pooled summary cohort characteristics were calculated for each outcome of interest. Methodological quality was assessed using the Newcastle-Ottawa Scale. The study was reported in accordance with the 2020 PRISMA statement.

RESULTS

Twenty-two studies were eligible for inclusion in the review, including 1094 patients, of whom 605 (55.3%) underwent ESC-H and 489 (44.7%) underwent SAC for nonsyndromic sagittal craniosynostosis. There was no difference between the pooled estimates of the ESC-H and SAC groups for operative time, length of stay, estimated blood loss, and cephalic index. There was no difference between the groups for reoperation rate and complication rate. However, ESC-H was associated with a higher blood transfusion rate and higher postoperative ICU admission.

CONCLUSIONS

The available literature does not demonstrate superiority of either ESC-H or SAC, and outcomes are broadly similar for the treatment of nonsyndromic sagittal craniosynostosis. However, the evidence is limited by single-center retrospective studies with low methodological quality. There is a need for international multicenter randomized controlled trials comparing both techniques to gain definitive and generalizable data.



中文翻译:

内窥镜带状颅骨切除术与成型头盔疗法与弹簧辅助颅骨成形术治疗非综合征性单缝矢状颅缝早闭:系统评价

客观的

内镜带状颅骨切除术联合术后成型头盔治疗 (ESC-H) 和弹簧辅助颅骨成形术 (SAC) 是常用的微创技术来矫正非综合征性矢状面颅缝早闭,但尚不清楚哪种技术更好。因此,作者进行了系统评价,比较了 ESC-H 与 SAC 在非综合征性单缝矢状颅缝早闭的手术治疗中的作用。

方法

通过对四个数据库(Embase、MEDLINE 和 Cochrane 图书馆中的两个数据库)进行系统和全面的搜索来确定研究。从开始到 2021 年 2 月 19 日,对数据库进行了搜索。包括接受 ESC-H 或 SAC 治疗非综合征性单缝线矢状颅缝早闭的儿科患者。系统评价和荟萃分析、单一患者病例报告、非综合征和综合征患者的混合队列、不同颅缝早闭类型的混合队列以及没有报告感兴趣结果的研究被排除在外。感兴趣的结果包括再次手术、输血、并发症、术后重症监护病房 (ICU) 入院、手术时间、估计失血量、住院时间和头颅指数。计算每个感兴趣的结果的汇总汇总队列特征。使用纽卡斯尔-渥太华量表评估方法学质量。该研究是根据 2020 PRISMA 声明报告的。

结果

22 项研究符合纳入评价的条件,包括 1094 名患者,其中 605 名(55.3%)接受了 ESC-H,489 名(44.7%)接受了非综合征矢状颅缝早闭的 SAC。ESC-H 组和 SAC 组在手术时间、住院时间、估计失血量和头颅指数方面的汇总估计值之间没有差异。各组再手术率和并发症发生率无差异。然而,ESC-H 与较高的输血率和较高的术后 ICU 入院率相关。

结论

现有文献没有证明 ESC-H 或 SAC 的优越性,非综合征矢状颅缝早闭的治疗结果大致相似。然而,证据受限于方法学质量低的单中心回顾性研究。需要进行国际多中心随机对照试验,比较这两种技术,以获得明确和可推广的数据。

更新日期:2022-08-05
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