{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:48:27Z","timestamp":1793166507225,"version":"4.5.0"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Endoscopic sagittal suturectomy (ESS) is commonly offered for sagittal craniosynostosis in infants, but the optimal timing of surgery remains controversial, with many clinicians only offering ESS surgery before 3 months of age. This study investigated whether patient age predicts craniometric correction and, more specifically, whether patients &gt; 3 months of age at surgery manifest less correction. The effects of age on blood transfusion were also investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A single-center retrospective review identifying patients with sagittal craniosynostosis who underwent ESS between 2009 and 2023 at Children\u2019s National Medical Center was performed. The authors stratified patients by age groups to compare outcomes and transfusion rates. Additionally, receiver operating characteristic (ROC) area under the curve (AUC) analysis was performed to identify optimal age cutoffs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In total, 107 patients were included. Stratifying age group by 0\u20132 months, 2\u20133 months, and &gt; 3 months revealed that the &gt; 3-month age group was less likely to achieve the target cephalic index (CI) at the final follow-up (48.8% vs 61.5% vs 25.0%, p = 0.031) and had less mean percentage CI change at the 6-month follow-up (17% \u00b1 8% vs 18% \u00b1 8% vs 12% \u00b1 6%, p = 0.011), helmet discontinuation (18% \u00b1 9% vs 18% \u00b1 8% vs 12% \u00b1 6%, p = 0.008), 1-year follow-up (15% \u00b1 9% vs 17% \u00b1 7% vs 10% \u00b1 7%, p = 0.005), and final follow-up (14% \u00b1 9% vs 15% \u00b1 7% vs 8% \u00b1 7%, p = 0.004). There were no differences in outcomes between groups when stratified as 0\u20132 months versus &gt; 2 months of age. The only difference in outcomes between groups when stratified as 0\u20133 months versus &gt; 3 months of age was the mean percentage change in CI at helmet removal (18% \u00b1 8% vs 15% \u00b1 7%, p = 0.044). Patients requiring transfusion were likely to be younger (median age 2 vs 3 months, p = 0.028). ROC curve analysis identified an age cut-point of 3.75 months as optimal for achieving the target CI correction at the final follow-up (AUC 0.58) and 2.75 months for transfusion avoidance (AUC 0.65).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Patients &gt; 3 months of age may benefit from ESS for sagittal craniosynostosis. Further investigation is warranted to identify the optimal age for surgery and to investigate other variables influencing outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.11.peds24272","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T21:29:58Z","timestamp":1740173398000},"page":"436-441","source":"Crossref","is-referenced-by-count":4,"title":["Optimal timing of endoscopic sagittal suturectomy"],"prefix":"10.3171","volume":"35","author":[{"given":"Patrick F.","family":"O\u2019Brien","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Medical Center, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saige A.","family":"Teti","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Medical Center, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callum","family":"Dewar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Walter Reed Medical Center, Bethesda, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Stabingas","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Medical Center, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Sohel","family":"Rana","sequence":"additional","affiliation":[{"name":"Joseph E. Robert Jr. Center for Surgical Care, Children\u2019s National Medical Center, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh N.","family":"Magge","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Medical Center, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Donoho","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Medical Center, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan R.","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Medical Center, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chima","family":"Oluigbo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Medical Center, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S.","family":"Myseros","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Medical Center, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary F.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Medical Center, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Keating","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Children\u2019s National Medical Center, Washington, DC;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Neurosurg Rev","first-page":"2533","article-title":"Endoscopic treatment of sagittal suture synostosis - a critical analysis of current management strategies","volume":"45","author":"Fassl V","year":"2022","unstructured":"Fassl V, Ellermann L, Reichelt G,  Endoscopic treatment of sagittal suture synostosis - a critical analysis of current management strategies. Neurosurg Rev. 2022;45(4):2533\u20132546."},{"issue":"3","key":"b2","series-title":"Transl Pediatr","first-page":"247","article-title":"Endoscopic craniosynostosis repair","volume":"3","author":"Proctor MR","year":"2014","unstructured":"Proctor MR. Endoscopic craniosynostosis repair. Transl Pediatr. 2014;3(3):247\u2013258."},{"issue":"4","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"352","article-title":"A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture","volume":"22","author":"Yan H","year":"2018","unstructured":"Yan H, Abel TJ, Alotaibi NM,  A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture. J Neurosurg Pediatr. 2018;22(4):352\u2013360."},{"key":"b4","series-title":"J Pediatr","first-page":"142","article-title":"Minimally invasive endoscopic surgery for infantile craniosynostosis: a longitudinal cohort study","volume":"216","author":"Riordan CP","year":"2020","unstructured":"Riordan CP, Zurakowski D, Meier PM,  Minimally invasive endoscopic surgery for infantile craniosynostosis: a longitudinal cohort study. J Pediatr. 2020;216:142\u2013149.e2."},{"issue":"6","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"620","article-title":"The management of sagittal synostosis using endoscopic suturectomy and postoperative helmet therapy","volume":"7","author":"Ridgway EB","year":"2011","unstructured":"Ridgway EB, Berry-Candelario J, Grondin RT, Rogers GF, Proctor MR. The management of sagittal synostosis using endoscopic suturectomy and postoperative helmet therapy. J Neurosurg Pediatr. 2011;7(6):620\u2013626."},{"issue":"3","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"277","article-title":"Multicenter comparison of head shape outcomes for three minimally invasive strip craniectomy techniques for sagittal craniosynostosis","volume":"32","author":"Rizvi I","year":"2023","unstructured":"Rizvi I, Hallac RR, Geisler EL,  Multicenter comparison of head shape outcomes for three minimally invasive strip craniectomy techniques for sagittal craniosynostosis. J Neurosurg Pediatr. 2023;32(3):277\u2013284."},{"issue":"5","key":"b7","series-title":"J Craniofac Surg","first-page":"1363","article-title":"Examining the role of early diagnostic imaging for craniosynostosis in the era of endoscopic suturectomy: a single institution experience","volume":"33","author":"Guadix SW","year":"2022","unstructured":"Guadix SW, Valenti A, Zappi KE,  Examining the role of early diagnostic imaging for craniosynostosis in the era of endoscopic suturectomy: a single institution experience. J Craniofac Surg. 2022;33(5):1363\u20131368."},{"key":"b8","series-title":"J Pediatr","first-page":"165","article-title":"Risk factors for delayed referral to a craniofacial specialist for treatment of craniosynostosis","volume":"186","author":"Gandolfi BM","year":"2017","unstructured":"Gandolfi BM, Sobol DL, Farjat AE, Allori AC, Muh CR, Marcus JR. Risk factors for delayed referral to a craniofacial specialist for treatment of craniosynostosis. 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Shanghai Jingshen Yixue. 2018;30(3):207\u2013212."},{"issue":"4","key":"b1","series-title":"Neurosurg Rev","first-page":"2533","article-title":"Endoscopic treatment of sagittal suture synostosis - a critical analysis of current management strategies","volume":"45","author":"Fassl V","year":"2022","unstructured":"Fassl V, Ellermann L, Reichelt G,  Endoscopic treatment of sagittal suture synostosis - a critical analysis of current management strategies. Neurosurg Rev. 2022;45(4):2533\u20132546."},{"issue":"3","key":"b2","series-title":"Transl Pediatr","first-page":"247","article-title":"Endoscopic craniosynostosis repair","volume":"3","author":"Proctor MR","year":"2014","unstructured":"Proctor MR. Endoscopic craniosynostosis repair. Transl Pediatr. 2014;3(3):247\u2013258."},{"issue":"4","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"352","article-title":"A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture","volume":"22","author":"Yan H","year":"2018","unstructured":"Yan H, Abel TJ, Alotaibi NM,  A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture. J Neurosurg Pediatr. 2018;22(4):352\u2013360."},{"key":"b4","series-title":"J Pediatr","first-page":"142","article-title":"Minimally invasive endoscopic surgery for infantile craniosynostosis: a longitudinal cohort study","volume":"216","author":"Riordan CP","year":"2020","unstructured":"Riordan CP, Zurakowski D, Meier PM,  Minimally invasive endoscopic surgery for infantile craniosynostosis: a longitudinal cohort study. J Pediatr. 2020;216:142\u2013149.e2."},{"issue":"6","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"620","article-title":"The management of sagittal synostosis using endoscopic suturectomy and postoperative helmet therapy","volume":"7","author":"Ridgway EB","year":"2011","unstructured":"Ridgway EB, Berry-Candelario J, Grondin RT, Rogers GF, Proctor MR. The management of sagittal synostosis using endoscopic suturectomy and postoperative helmet therapy. J Neurosurg Pediatr. 2011;7(6):620\u2013626."},{"issue":"3","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"277","article-title":"Multicenter comparison of head shape outcomes for three minimally invasive strip craniectomy techniques for sagittal craniosynostosis","volume":"32","author":"Rizvi I","year":"2023","unstructured":"Rizvi I, Hallac RR, Geisler EL,  Multicenter comparison of head shape outcomes for three minimally invasive strip craniectomy techniques for sagittal craniosynostosis. 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J Pediatr. 2017;186:165\u2013171.e2."},{"key":"b9","article-title":"Craniosynostosis: Diagnosis, Evaluation, and Management","author":"Cohen MM","year":"2000","unstructured":"Cohen MM, MacLean RE. Craniosynostosis: Diagnosis, Evaluation, and Management. 2nd ed. Oxford University Press; 2000."},{"issue":"3","key":"b10","series-title":"Shanghai Jingshen Yixue","first-page":"207","article-title":"Assessing the accuracy of diagnostic tests","volume":"30","author":"Li F","year":"2018","unstructured":"Li F, He H. Assessing the accuracy of diagnostic tests. Shanghai Jingshen Yixue. 2018;30(3):207\u2013212."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/35\/5\/article-p436.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/35\/5\/article-p436.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/35\/5\/article-p436.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:46:19Z","timestamp":1772804779000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/35\/5\/article-p436.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,1]]},"references-count":20,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2024.11.peds24272","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,1]]}}}