Endoscopic treatment of isolated unilateral lambdoid craniosynostosis: preoperative craniofacial metrics and ongoing postoperative improvement in craniofacial deformity over time

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OBJECTIVE: There is a paucity of data on the treatment options and long-term outcomes of isolated unilateral lambdoid craniosynostosis. The authors aimed to present a 28-year experience treating isolated unilateral lambdoid craniosynostosis with endoscopy-assisted strip craniectomy treatment and postoperative cranial orthotic therapy for various age groups, and provide objective craniofacial measurements and long-term outcomes of this approach to help guide management. METHODS: A retrospective review of all children with craniosynostosis treated endoscopically for isolated lambdoid involvement from 1996 to 2024 was performed. The surgical technique involved two 2-cm incisions, one of which was lateral to the lambda on the affected side and another medial and superior to the asterion. Using endoscopy-assisted visualization, a strip craniectomy was performed between the aforementioned anatomical landmarks. Following surgery, cranial orthoses were used to assist in the correction of craniofacial deformities. Pre- and postoperative photographs were analyzed for correction of 3 craniofacial deformities: facial twist, posterior cranial scoliosis, and mastoid tilt. RESULTS: Thirty-two children (17 male, mean age 7 months) with isolated unilateral lambdoid craniosynostosis who were followed up from 5 months to 11 years after surgery were included in the analysis. The mean ± SD preoperative facial twist was 9.12° ± 3.48° (range 5°-17.5°); there was a significant difference between the preoperative and last available postoperative measurements (mean improvement 6.26° ± 4.09°, percentage difference of -57.04%, p < 0.001). The mean preoperative posterior cranial scoliosis was 12° ± 3.71° (range 3°-17.75°); there was a significant difference between the preoperative and last available postoperative measurements (mean improvement 8.45° ± 3.68°, percentage difference of -57.88%, p < 0.001). The mean preoperative mastoid tilt was 11.31° ± 2.52° (range 7°-17.5°); there was a significant difference between the preoperative and last available postoperative measurements (mean improvement 7.52° ± 3.63°, percentage difference of -64.67%, p < 0.001). The mean estimated blood loss was 13.13 mL, and no patient required blood transfusion. The mean craniectomy width and length were 5 mm and 91 mm, respectively. Complications included 1 infection (3.13%), and all children were discharged home on the 1st postoperative day. CONCLUSIONS: Endoscopy-assisted strip craniectomy for treatment of unilateral lambdoid craniosynostosis was associated with excellent long-term results, with ongoing improvement in all 3 craniofacial measurements over time. The procedure had short operative times, minimal blood loss, and minimal complications. Moreover, the craniofacial measurements presented herein are more specific to lambdoid craniosynostosis, provide more accurate diagnosis, and allow for comparative follow-up with other approaches. Endoscopy-assisted strip craniectomy should be performed in children presenting early to a specialized center.

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