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Authors: Esther Cleveland Beeson Dupepe, MSPH, MD; Ema Zubovic, MD; Jodi Lapidus; Gary Skolnick, BS; Sybill Naidoo, PhD; Matthew Smyth, MD; Kamlesh Patel, MD (St Louis, MO)


Management of craniosynostosis at an early age mitigates the risk of abnormal cranial development but can incur significant expenses. Previous research shows that endoscope-assisted craniectomy (EAC) is less costly than open cranial vault remodeling (CVR) for patients with sagittal synostosis. The aim of this study is to elucidate the charges for open versus endoscopic treatment for patients with non-sagittal synostoses.


We performed a retrospective analysis of 41 patients who underwent open cranial vault remodeling and 38 who underwent endoscope-assisted craniectomy with postoperative helmet therapy for non-sagittal single-suture craniosynostoses (metopic, coronal, and lambdoid) between 2008 and 2018. All patients were < 1 year of age at time of surgery with minimum 1 year follow up.  Inpatient charges, physician fees, helmet charges, and outpatient clinic visits in the first year were analyzed.


The mean age of children treated with endoscope-assisted craniectomy and open cranial vault remodeling was 3.5 months and 8.7 months, respectively. Patients undergoing EAC with postoperative helmet therapy required more outpatient clinic in the first year compared with patients undergoing CVR (4 vs. 2, p < 0.001). 13% of patients in the EAC group required 1 helmet, 30% required 2 helmets, 40% required 3 helmets, and 13% required 4 or more helmets, with an average total helmeting cost of $10,072. The total charges for were significantly lower for EAC than for open CVR ($50,840 vs. $95,588 , p < 0.001).


Despite the additional charges incurred with postoperative helmet therapy and more frequent outpatient visits, hospital associated charges associated with endoscope-assisted craniectomy are significantly less than open cranial vault remodeling for patients with metopic, coronal, and lambdoid craniosynostosis. In conjunction with the existing literature on clinical outcomes and perioperative resource utilization, this data supports EAC as a cost-effective treatment option.