Minimally invasive strip craniectomy with orthotic helmet therapy (SCOT) is an increasingly supported treatment for metopic craniosynostosis, though the long-term efficacy of deformity correction remains poorly defined. We sought to compare the long-term outcomes of SCOT versus open cranial vault reconstruction (OCVR).Methods: Patients who underwent OCVR or SCOT for isolated metopic synostosis were identified. Inclusion criteria included preoperative imaging and at least 3 years of follow-up. Interfrontal angle and interzygomaticofrontal distance were measured from preoperative imaging to assess baseline severity. At latest follow up, anthropometric measurements were made from postoperative 3D photos to assess skull morphology and all patients parents completed satisfaction surveys. Independent adolescent and craniofacial surgeon raters, blinded to the treatment of each patient, rated the appearance of postoperative 3D photos.
Thirty-five patients were included (15 SCOT and 20 OCVR). Mean follow-up time was similar for both groups (SCOT 7.9 ± 3.2 years vs. OCVR 9.2±4.1 years, p=0.33). Baseline severity between groups was similar in both interfrontal angle (SCOT 116.6°±8.8° vs. OCVR 110.5°±10.1°, p=0.07) and interzygomaticofrontal distance (SCOT 67.5±6.8 mm vs. OCVR 66.5±8.6 mm, p=0.75). Postoperatively, all anthropometrics were equivalent including glabellar angle, frontal width, and intercanthal width (p>0.05, all comparisons). Parents of patients who underwent SCOT and OCVR reported equivalent levels of satisfaction with the overall results of the surgery (100% vs. 95%, p>0.99). Adolescent raters found that the appearance of SCOT patients was more normal than that of OCVR patients (p=0.04), and equivalent to that of normal controls (p=0.31). Craniofacial surgeons assigned Whitaker class I to a greater proportion of SCOT patients (75.6%±6.4%) compared to OCVR patients (43.3%±9.5%, p=0.02).
In patients with metopic craniosynostosis, minimally invasive strip craniectomy with orthotic helmet therapy was associated with superior objective appearance compared to open cranial vault reconstruction, with equivalent long-term morphologic outcomes and patient satisfaction.