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Systematic Review

Comparison of Surgical Techniques in Managing Craniosynostosis: Systematic Review and Bayesian Network Meta-Analysis

by
Muhammad Ikhlas Abdian Putra
1,
Mirnasari Amirsyah
1,*,
Budiman Budiman
2,
Shakira Amirah
3,
Seba Talat Al-Gunaid
4 and
Muhammad Iqhrammullah
5,*
1
Plastic Reconstructive and Aesthetic Surgery Subdivision, Department of Surgery, Zainoel Abidin General Hospital, Medical Faculty of Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
2
Plastic Reconstructive and Aesthetic Surgery Subdivision, Department of Surgery, Gatot Soebroto Army Central Hospital, Medical Faculty of Universitas Syiah Kuala, Jakarta 10410, Indonesia
3
Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
4
School of Medicine, Universitas Syiah Kuala, Banda Aceh 23243, Indonesia
5
Postgraduate Program of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh 23123, Indonesia
*
Authors to whom correspondence should be addressed.
Surgeries 2024, 5(4), 970-985; https://doi.org/10.3390/surgeries5040078
Submission received: 26 September 2024 / Revised: 9 October 2024 / Accepted: 23 October 2024 / Published: 28 October 2024

Abstract

Open total cranial vault reconstruction (CVR) is the common procedure in managing craniosynostosis, yet more techniques have been introduced as alternatives, namely endoscopic suturectomy (ES), endoscopy-assisted craniectomy (EC), spring-assisted surgery (SAS), strip craniectomy with helmet (SC), Pi craniectomy (PiC), Pi plasty (PiP), and Renier’s “H” technique (RH). The aim of this study was to compare the effectiveness of craniosynostosis surgeries in improving the cephalic index of the patients. Studies published until 7 March 2024 reporting CVR, ES, SAS, SC, RH, and PiP as definitive craniosynostosis management with the cephalic index as the outcome were included. Bayesian network meta-analysis and pair-wise meta-analysis were performed using a random-effects model based on standardized mean difference (SMD) and 95% confidence interval (CI). Nine studies published in 2008–2024 recruiting a total of 464 craniosynostosis patients (age: 18–61 months) were included in this meta-analysis. EC (SMD = 0.23 [95%CI: −5.47 to 5.63]; p = 0.935), PiP (SMD = −0.07 [95%CI: −9.27 to 8.79]; p = 0.988), ES (SMD = −0.59 [95%CI: −6.07 to 4.94]; p = 0.834), PiC (SMD = −1.16 [95%CI: −8.89 to 6.35]; p = 0.765), RH (SMD = −0.96 [95%CI: −6.62 to 4.53]; p = 0.736), SAS (SMD = −0.86 [95%CI: −8.25 to 6.18]; p = 0.815), and SC (SMD = −1.79 [95%CI: −9.05 to 5.28]; p = 0.624) were found to be as effective as CVR in improving the cephalic index. Network meta-analysis suggests that PiP is the most effective among these techniques (rank 1 probability = 0.273). According to the rank probabilities of our model the order of techniques from the most to the least effective is as follows: EC > CVR > PiP > ES > SAS > RH > PiC > SC.
Keywords: Bayesian; craniosynostosis; cranial vault reconstruction; endoscopic suturectomy; pi-plasty Bayesian; craniosynostosis; cranial vault reconstruction; endoscopic suturectomy; pi-plasty
Graphical Abstract

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MDPI and ACS Style

Putra, M.I.A.; Amirsyah, M.; Budiman, B.; Amirah, S.; Al-Gunaid, S.T.; Iqhrammullah, M. Comparison of Surgical Techniques in Managing Craniosynostosis: Systematic Review and Bayesian Network Meta-Analysis. Surgeries 2024, 5, 970-985. https://doi.org/10.3390/surgeries5040078

AMA Style

Putra MIA, Amirsyah M, Budiman B, Amirah S, Al-Gunaid ST, Iqhrammullah M. Comparison of Surgical Techniques in Managing Craniosynostosis: Systematic Review and Bayesian Network Meta-Analysis. Surgeries. 2024; 5(4):970-985. https://doi.org/10.3390/surgeries5040078

Chicago/Turabian Style

Putra, Muhammad Ikhlas Abdian, Mirnasari Amirsyah, Budiman Budiman, Shakira Amirah, Seba Talat Al-Gunaid, and Muhammad Iqhrammullah. 2024. "Comparison of Surgical Techniques in Managing Craniosynostosis: Systematic Review and Bayesian Network Meta-Analysis" Surgeries 5, no. 4: 970-985. https://doi.org/10.3390/surgeries5040078

APA Style

Putra, M. I. A., Amirsyah, M., Budiman, B., Amirah, S., Al-Gunaid, S. T., & Iqhrammullah, M. (2024). Comparison of Surgical Techniques in Managing Craniosynostosis: Systematic Review and Bayesian Network Meta-Analysis. Surgeries, 5(4), 970-985. https://doi.org/10.3390/surgeries5040078

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