Surgical Outcomes of Strip Craniectomy in Metopic Craniosynostosis without Orthotic Helmet Therapy

Abstract

Objective: To evaluate the clinical and cosmetic outcomes of strip craniectomy performed without postoperative orthotic helmet therapy in infants diagnosed with trigonocephaly.

Materials and Methods: A prospective single-centre study was carried out at the Department of Pediatric Neurosurgery, The Children's Hospital Lahore, over a period spanning November 2021 to July 2023. Thirty consecutive patients under four months of age with confirmed metopic craniosynostosis were enrolled. All patients underwent strip craniectomy and were followed for twelve months postoperatively. Operative and outcome data were analyzed using SPSS version 27.

Results: The cohort comprised 30 patients with a mean age of 3.3 ± 0.8 months; 19 were male (63.3%), and 11 were female (36.7%). Mean operative duration was 58.2 ± 5.7 minutes, with an average blood loss of 30 ± 5 mL. Perioperative complications included surgical site infection in two patients and a dural laceration in one, repaired intraoperatively without sequelae. No venous sinus injuries, air embolism, seizures, intracranial hemorrhage, or neurological deficits were recorded. Mean postoperative hospital stay was 3.0 ± 0.5 days. OFC improved from a preoperative mean of 39 ± 1.5 cm to 42 ± 1.4 cm at twelve months.

Conclusion: Strip craniectomy performed without adjunctive helmet therapy is a safe and effective intervention for trigonocephaly in resource-limited environments. Operating between 3 and 6 months of age leverages the plasticity of the neonatal calvaria and rapid cerebral expansion. Future multicenter studies with larger cohorts are needed to validate these findings.