Cephalometric Comparison Of Open Versus Endoscopic Repair In Isolated Metopic Synostosis

PURPOSE: Cosmetic outcomes remain a central consideration in surgical management of isolated metopic synostosis. This study compares cranial morphology following open versus endoscopic repair using quantitative cephalometric analysis. METHODS: We conducted a single-institution retrospective study of patients who underwent either open or endoscopic correction of metopic craniosynostosis. Cephalometric parameters, including biparietal and anteroposterior diameters, cephalic index, and the frontal angle at 30 mm (Fa30), were measured via CT and 3D stereophotogrammetry. Preoperative and postoperative values at one year follow up were obtained in the open cohort and after completion of cranial orthosis in the endoscopic cohort. RESULTS: Forty-six patients met inclusion criteria (26 open, 20 endoscopic). Both techniques produced significant postoperative improvement across all cephalometric dimensions. Groups did not differ significantly in postoperative anteroposterior diameter (p = 0.53), cephalic index (p = 0.74), or biparietal distance (p = 0.05). However, endoscopic repair was associated with a significantly smaller postoperative Fa30 compared to open repair (131.8° vs. 136.6°, CI [-7.85, -1.72], p = 0.003). CONCLUSION: Open and endoscopic repair both achieve measurable improvement in cranial morphology for metopic synostosis. While global cephalometric outcomes are comparable between techniques, open repair demonstrated superior correction of the frontal angle, a key determinant of forehead contour and cosmesis. These findings highlight the nuanced tradeoffs between minimally invasive and open techniques, informing surgical decision-making and counseling of families.