Treatment of unilateral coronal synostosis by endoscopic strip craniectomy or fronto-orbital advancement: Ophthalmologic findings

BACKGROUND Unilateral coronal synostosis results in ipsilateral retrusion. of the forehead and superior orbital rim, shortening the elevation of the orbital roof and contralateral frontal bossing and orbital roof depression. This craniosynostosis is associated with the development of V-pattern strabismus and aniso-astigmatism. Since 2004 endoscopic strip craniectomy performed in patients by 3 months of age has been offered as an alternative to fronto-orbital advancement at 9 to 11 months of age. We compare the incidence and severity of V-pattern strabismus and aniso-astigmatism in children treated by these 2 procedures. METHODS A retrospective review identified 37 children with unilateral coronal synostosis treated with either fronto-orbital advancement or endoscopic strip craniectomy. Incidence and severity of V-pattern strabismus, fundus excyclotorsion, and aniso-astigmatism was recorded for an (gearly" examination (between 2 and 14 months of age) and a "late" examination (between 14 and 45 months of age). RESULTS Early examination revealed no statistical difference in severity of V-pattern strabismus or aniso-astigmatism between the 2 groups. At late examination there was a trend toward greater severity of V-pattern strabismus, an increase in excyclotorsion, and a statistically significant increase in the standard deviation of aniso-astigmatism in the cohort of children treated by fronto-orbital advancement. CONCLUSIONS Children With unilateral coronal synostosis treated by early endoscopic strip craniectomy may develop less severe V-pattern strabismus, excyclotorsion, and range of aniso-astigmatism than those treated by later fronto-orbital advancement. This is an early, retrospective, nonrandomized study with a short follow-up period; longer follow-up is necessary to confirm these results. (J AAPOS 2009;13:155-160)