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Objective: This study reports the authors' experience with surgical interventions for nonsyndromic craniosynostosis. They assessed open surgery and minimally invasive endoscopic suturectomy in terms of periprocedural outcomes and related risk factors for postoperative complications and reoperation. This study aimed to provide insights toward surgical approach decisions and lay the groundwork for future prospective studies in this field., Methods: In this retrospective cohort study, the medical records of all patients with nonsyndromic craniosynostosis who underwent primary surgery at the authors' center from 2014 to 2024 were analyzed. The authors assessed open surgery and endoscopic suturectomy based on anesthesia time, length of hospitalization, hematological parameters, postoperative blood transfusion volume, and changes in head circumference percentile (HCP). A subgroup analysis was conducted for patients younger than 6 months across different types of craniosynostosis. Further investigation was conducted to identify potential risk factors for postoperative complications and reoperation., Results: A total of 633 pediatric patients treated for nonsyndromic craniosynostosis were included in this study (281 with endoscopic suturectomy, 352 with open surgery). These data indicated a growing trend for endoscopic procedures. The authors' center began performing endoscopic surgery in 2014, and by 2024, 75% of craniosynostosis patients underwent this procedure (p < 0.001). Patients in the endoscopic group experienced shorter anesthesia times (p < 0.001), reduced lengths of hospitalization (p < 0.001), and lower blood transfusion volumes (p < 0.001) compared with those in the open surgery group; however, blood transfusion volume differences were not significant in the subgroup analysis. The subgroup analysis revealed comparable HCP changes in sagittal (p = 0.4) and coronal (p = 0.85) craniosynostosis. In comparison, greater changes were noted after open surgery in cases of metopic (p = 0.03) and multisuture (p = 0.04) craniosynostosis. The rates of postoperative complications (endoscopic 6.4% and open 4.5%) and reoperation (endoscopic 4.6% and open 2.8%) were comparable between the two groups. In univariate analysis, higher weight (OR 1.07, p < 0.05) was identified as the only risk factor for postoperative complications, which can be attributed to delayed surgical intervention. Coronal (OR 8.38, p < 0.05) and multisuture (OR 23.66, p < 0.01) craniosynostoses were associated with higher reoperation rates, while adding barrel stave osteotomies was linked to a lower reoperation rate (OR 0.22, p < 0.05)., Conclusions: Endoscopic suturectomy is associated with acceptable periprocedural outcomes compared with open surgery, with comparable rates of complications and reoperation. These findings are supported by the subgroup analysis. However, further studies focusing on craniometric outcomes are needed, as surgical procedures have shown variable results across different types of craniosynostosis.

Objective: Craniosynostosis surgery is associated with considerable blood loss and need for transfusion. Considering the lower estimated blood volume (EBV) of children compared to adults, excessive blood loss may quickly lead to hypovolemic shock. Therefore, reducing blood loss is important in craniosynostosis surgery. This study was conducted to evaluate the efficacy of aprotinin or tranexamic acid (TXA) in blood loss reduction in these patients., Methods: In the current randomized controlled trial, 90 eligible pediatric patients with craniosynostosis were randomly divided into three groups to receive either aprotinin, TXA, or no intervention. The absolute blood loss and transfusion amount were assessed for all patients both intraoperatively and 2 and 8 hours postoperatively., Results: Although crude values of estimated blood loss were not significantly different between groups (p = 0.162), when adjusted to the patient's weight or EBV, the values reached the significance level (p = 0.018), particularly when the aprotinin group was compared to the control group (p = 0.0154). The EBV losses 2 hours and 8 hours postoperatively significantly dropped in the TXA and aprotinin groups compared to the control group (p = 0.001 and p < 0.001, respectively). Rates of postoperative blood transfusion were significantly higher in the control group (p = 0.024). Hemoglobin and hematocrit 8 hours postoperatively were lower in the control group than in the TXA or aprotinin treatment groups (p < 0.002 and p < 0.001, respectively). There were no serious adverse events associated with the interventions in this study., Conclusions: Aprotinin and TXA can reduce blood loss and blood transfusion without serious complications and adverse events in pediatric patients undergoing craniosynostosis surgery.