Surgical treatment of isolated and syndromic craniosynostosis: Results and complications in 283 consecutive cases

Abstract

SummaryObjective. To review the results and complications of the surgical treatment of craniosynostosis in 283 consecutive patients treated between 1999 and 2007.Patients and methods. Our series consisted of 330 procedures performed in 283 patients diagnosed with scaphocephaly (n=155), trigonocephaly (n=50), anterior plagiocephaly (n=28), occipital plagiocephaly (n=1), non-syndromic multi-suture synostosis (n=20), and with diverse craniofacial syndromes (n=32; 11 Crouzon, 11 Apert, 7 Pfeiffer, 2 Saethre-Chotzen, and 2 clover-leaf skull). We used the classification of Whitaker et al. to evaluate the surgical results. Complications of each technique and time of patients' hospitalization were also recorded. The surgeries were classified in 12 different types according to the techniques used. Type I comprised endoscopic assisted osteotomies for sagittal synostosis (42 cases). Type II included sagittal suturectomy and expanding osteotomies (46 cases). Type III encompassed procedures similar to type II but that included frontal dismantling or frontal osteotomies in scaphocephaly (59 cases). Type IV referred to complete cranial vault remodelling (holocranial dismantling) in scaphocephaly (13 cases). Type V belonged to fronto-orbital remodelling without fronto-orbital bandeau in trigonocephaly (50 cases). Type VI included fronto-orbital remodelling without fronto-orbital bandeau in plagiocephaly (14 cases). In Type VII cases of plagiocephaly with frontoorbital remodelling and fronto-orbital bandeau were comprised (14 cases). Type VIII consisted of occipital advancement in posterior plagiocephaly (1 case). Type IX included standard bilateral fronto-orbital advancement with expanding osteotomies (30 cases). Type X was used in multi-suture craniosynostosis (15 cases) and consisted of holocranial dismantling (complete cranial vault remodelling). Type XI included occipital and suboccipital craniectomies in multiple suture craniosynostosis (10 cases) and Type XII instances of fronto-orbital distraction (26 cases).Results. The mortality rate of the series was 2 out of 283 cases (0.7%). These 2 patients died one year after surgery. All complications were resolved without permanent deficit. Mean age at surgery was 6.75 months. According to Whitaker et al's classification, 191 patients were classified into Category I (67.49%), 51 into Category II (18.02%), 30 into Category III (10.6%) and 14 into Category IV (4.90%). Regarding to craniofacial conformation, 85.5 % of patients were considered as a good result and 15.5% of patients as a poor result. Of the patients with poor results, 6.36% were craniofacial syndromes, 2.12% had anterior plagiocephaly and 1.76% belonged to non-syndromic craniosynostosis.The most frequent complication was postoperative hyperthermia of undetermined origin (13.43% of the cases), followed by infection (7.5%), subcutaneous haematoma (5.3%), dural tears (5%), and CSF leakage (2.5%). The number of complications was higher in the group of re-operated patients (12.8% of all). In this subset of reoperations, i...

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

“…The rate of dural tears (4.3%) is comparable to that seen in the literature. 1,5,6 The mean complication rates in the OCVRS group in the present study (13.6%, 95% CI 7.4-24) was higher than what has been reported in literature (6.8%), 1,8,22,25 which is partly the result of syndromic craniosynostosis cases and IOCs having been excluded in these studies. Our complication rate for syndromic cases treated with OCVRS was 25%, but this rate derives from a single complication occurring in a cohort of 4 patients.…”

Transsutural distraction osteogenesis for 285 children with craniosynostosis: a single-institution experience

“…In another report by Esparza et al 6 of a series of 283 patients, 95 (33.6%) were above Whitaker classification Category 2 requiring cosmetic surgery, while our results did not show any patients with Category 5 or higher after more than 1 year of followup, demonstrating better outcomes than those of previous authors.…”

“…14,21,22 With regard to infection, considered the most serious complication of distractor DO, repeat surgery due to infection or a wound after spring DO has been shown to be 0%-4%, and early distractor removal for the same reasons has been reported as 0%-3.3%. [3][4][5][6]9,12,18,21,29,30 In contrast, our incidence of repeat surgery for infection or a wound after distractor DO was 1.1%, and the incidence of early distractor removal for the above reasons was 3.9% in this study. Therefore, we hypothesize that there is no significant difference between distractor DO and spring DO in terms of the incidence of infection.…”

“…5,6,13 In contrast, complications related to DO that have been reported are CSF leakage, distractor breakage, distractor malfunction, spring dislodgement, overcorrection, undercorrection, and subgaleal hemorrhage from delayed sinus tears. Moreover, studies that have reported DO complications in more than 10 patients are even fewer, and are summarized in Table 8.…”

Endoscopic-Assisted Craniosynostosis Surgery

“…Recently, more centers have undertaken this technique to enlarge their surgical options addressing skull and facial deformities. [3][4][5][6][7][8][9][10][11][12][13][14] The author presents his series of endoscopic-assisted craniosynostosis surgery at Cook Children's hospital in Fort Worth, Texas.…”