Craniosynostosis is a developmental craniofacial anomaly, resulting in impairment of brain development and abnormally shaped skull. The main cause of craniosynostosis is premature closure of one or more cranial sutures [1]. The most common suture to be affected is the sagittal suture, which results in an elongated and narrow skull. The other affected sutures are metopic suture, unilateral coronal suture, bilateral coronal sutures, and the lambdoid suture [2]. It usually occurs as an isolated condition but may also be associated with other malformations as part of complex syndromes [1], such as: Apert syndrome; Crouzon syndrome; Pfeiffer syndrome; Saethre-Chotzen syndrome; and Muenke syndrome [3].

Traditional repairs for these conditions over the past 3–4 decades have involved an open operation with a large skin incision and major manipulations of the skull bones. More recently, minimally invasive endoscopic techniques have been developed to release the calvarial vault, followed by postoperative treatment with either an external orthosis (helmet therapy) or internal springs and distractors to achieve the desired correction [2].

Multiple studies have now shown that the endoscopic techniques afford a much shorter surgical time, significantly less blood loss and significantly lower blood transfusion rates, ² as well as shorter hospital stays [4]. Nevertheless, despite the numerous recorded advantages of endoscopic correction, the handling of craniosynostosis exhibits substantial variations in literature, lacking a unanimous agreement regarding the optimal timing and surgical approach for its repair. To address this knowledge gap, it was devised a systematic review and single-arm meta-analysis that explore and provide insights into the endoscopic approach to craniosynostosis, reviewing intraoperative management, related complications and post-operative follow-up and clinical outcomes.