Twenty-Year Outcomes Experience with Primary Open Craniosynostosis Repairs: An Analysis of Reoperation and Complication Rates
Kerry A. Morrison, M.D.1, James C. Lee, M.D.1, Mark M. Souweidane, M.D.2, Neil A. Feldstein, M.D.3, Jeffrey A. Ascherman, M.D.1.
1Columbia University College of Physicians and Surgeons, Division of Plastic Surgery, New York, NY, USA, 2Weill Cornell Medical College, Department of Neurological Surgery, New York, NY, USA, 3Columbia University College of Physicians and Surgeons, Department of Neurological Surgery, New York, NY, USA.
BACKGROUND: Craniosynostosis results from the premature fusion of single or multiple cranial sutures of the skull, leading to calvarial growth restrictions and predictable compensatory deformations with both aesthetic and neurological sequelae. Surgical intervention during infancy remains the gold standard of treatment with the two main surgical options being open cranial vault remodeling versus minimally invasive surgery. Early surgical intervention for both syndromic and non-syndromic patients alike is advocated in the literature to facilitate appropriate craniofacial growth, to reduce neurologic complications secondary to increased intracranial pressure, and to mitigate psychosocial morbidity. While open cranial vault remodeling was initially considered a high-risk procedure, many advances have improved the safety and predictability of this open surgical approach over the past few decades. Despite this, there are few studies on the long-term outcomes of contemporary open craniosynostosis repair. Herein, we sought to review the safety profile and complication rates of primary open craniosynostosis repairs at a single institution over a 20-year period.
METHODS: A retrospective review of all patients who underwent primary open cranial vault repair for craniosynostosis by a single surgeon (JAA) at New York-Presbyterian Hospital from 1995 to 2015 was performed. Data including patient demographics, syndromic involvement, sutures affected, age at operation, medical history, perioperative events, operative time, estimated blood loss, transfusion requirements, hospital length of stay, post-operative complications, and reoperation rates were collected and analyzed.
RESULTS: Data from 82 patients (47 males, 35 females) were analyzed. For primary open repair, affected sutures included unicoronal (28), bicoronal (8), metopic (24), sagittal (11), lambdoid (2), and multi-suture (9). Sagittal synostosis patients less than six months of age were often treated by the neurosurgical team alone, without the involvement of plastic surgery, and thus were not included in this analysis. Fifteen patients (18.3%) were syndromic, with Crouzon and Apert syndromes being the most common. Nine patients (11.0%) had multiple suture involvement. At the time of primary open cranial vault repair, the mean patient age was 13.76±16.14 months. Specifically, 34 (41%) were 0-6 months of age, 27 (33%) were 7-12 months of age, and 21 (26%) were older than 12 months of age at the time of primary repair. There were no intraoperative complications. Mean estimated intraoperative blood loss (EBL) for the plastic surgery portion of all cases was 74.53±72.34 cc, and total EBL was 174.93±182.23 cc. Mean hospital length of stay was 4.31±1.59 days. One syndromic patient was readmitted for wound infection (1.2%) that was successfully treated with intravenous antibiotics, and one patient (1.2%) had extrusion of absorbable hardware that resolved with conservative treatment. Additionally, two syndromic patients (2.4%) had later reoperation for fronto-orbital re-advancement.
CONCLUSIONS: This 20-year experience demonstrates the safety and low reoperation rate of modern open craniosynostosis repair in single-suture, multiple-suture, and syndromic patients at a large academic medical center. Our data demonstrates a 0% mortality, 0% intraoperative complication rate, and very low (2.4%) readmission rate. These results provide a valuable outcomes metric for providers and families considering open surgical treatment of craniosynostosis, including in children with craniofacial syndromes.
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