The temporal region in unilateral coronal craniosynostosis: Fronto-orbital advancement versus endoscopy-assisted strip craniectomy

Objective: To compare postoperative temporal expansion in patients treated with fronto-orbital advancement or endoscopyassisted craniectomy with cranial orthotic therapy. Design: This is a retrospective, multicenter cohort study of patients with unilateral coronal craniosynostosis (UCS). Setting: Computed tomographic (CT) scans were drawn from UCS patients treated at Boston Children’s Hospital or St Louis Children’s Hospital. Patients: The study included 56 patients with UCS after fronto-orbital advancement (n = 32) or endoscopic repair (n = 24) and 10 age-matched controls. Intervention: Fronto-orbital advancement entails a craniotomy of the frontal bone and superior orbital rim followed by reshaping and forward advancement. Endoscopic repair is the release of the synostotic suture and guidance of further growth of the cranium using a molding orthotic. Main Outcome Measures: Measures included posterior temporal width, anterior temporal width, orbital width, and anterior cranial fossa area taken preoperatively and 1 year postoperatively. Linear regression was performed to assess 1 year postoperative improvement in symmetry; covariates included preoperative symmetry and type of surgery. Results: Both treatments showed improvement in orbital width and anterior cranial fossa area symmetry 1 year postoperatively (P < .001), but no significant improvement in posterior or anterior temporal width symmetry. Linear regression revealed no difference between the 2 procedures in any of the 4 measurements (.096 ≤ P ≤ .898). Conclusions: Fronto-orbital advancement and endoscopic repair show equivalent outcomes 1 year postoperatively in all 3 width measurements and anterior cranial fossa area. Neither procedure produced significant improvement in temporal width.