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Twenty-Year Outcome Experience With Open Craniosynostosis Repairs: An Analysis of Reoperation and Complication Rates

Morrison, Kerry, A., MD*; Lee, James, C., MD*; Souweidane, Mark, M., MD; Feldstein, Neil, A., MD; Ascherman, Jeffrey, A., MD*

doi: 10.1097/SAP.0000000000001365
Clinical Papers

Background Surgical intervention during infancy for both syndromic and nonsyndromic patients with craniosynostosis remains the criterion standard of treatment with the 2 main options being open vault remodeling versus minimally invasive surgery. Although open cranial vault remodeling was initially considered a high-risk procedure, many advances have improved its safety. Despite this, there is a paucity of literature on the long-term outcomes of contemporary open craniosynostosis repair.

Methods A retrospective review of all patients who underwent primary open cranial vault repair for craniosynostosis by a single surgeon (J.A.A.) at New York-Presbyterian Hospital from 1995 to 2015 was performed.

Results For primary open repair, 81 patients (46 males, 35 females) were analyzed, and affected sutures included unicoronal (28), bicoronal (7), metopic (24), sagittal (11), lambdoid (2), and multisuture (9). Fourteen patients (17.3%) were syndromic. Mean (SD) operative patient age was 13.81 (16.24) months: 34 (42%) were 0 to 6 months; 26 (32%), 7 to 12 months; and 21 (26%), 12 months of age or older. There were no intraoperative complications. Mean (SD) estimated blood loss for the plastic surgery portion of all cases was 74.53 (72.34) mL, and total estimated blood loss was 174.93 (182.23) mL. Mean (SD) hospital length of stay was 4.31 (1.59) days. One syndromic patient was readmitted for a wound infection (1.2%) that was successfully treated with antibiotics, and 2 syndromic patients (2.5%) had reoperation for fronto-orbital readvancement.

Conclusions This 20-year experience demonstrates the safety of modern open craniosynostosis repairs at a large academic medical center with low rates of mortality (0%), complications (1.2%), and reoperations (2.5%).

From the *Division of Plastic Surgery, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York Presbyterian Hospital; †Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College; and ‡Department of Neurosurgery, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY.

Received December 4, 2017, and accepted for publication, after revision December 21, 2017.

Conflicts of interest and sources of funding: none declared.

Reprints: Jeffrey A. Ascherman, MD, Columbia University Medical Center, 161 Fort Washington Ave, Suite 511, New York, NY 10032. E-mail:

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