Muhammad Ikhlas Abdian Putra, Mirnasari Amirsyah, Budiman Budiman, Shakira Amirah, Seba Talat Al-Gunaid, Muhammad Iqhrammullah
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. © 2024 by the authors.
Plastic Reconstructive and Aesthetic Surgery Subdivision, Department of Surgery, Zainoel Abidin General Hospital, Medical Faculty of Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia; Plastic Reconstructive and Aesthetic Surgery Subdivision, Department of Surgery, Gatot Soebroto Army Central Hospital, Medical Faculty of Universitas Syiah Kuala, Jakarta, 10410, Indonesia; Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia; School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23243, Indonesia; Postgraduate Program of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, 23123, Indonesia
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