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Long-Term Outcomes of Primary Craniofacial Reconstruction for Craniosynostosis: A 12-Year Experience

Seruya, Mitchel M.D.; Oh, Albert K. M.D.; Boyajian, Michael J. M.D.; Posnick, Jeffrey C. D.M.D., M.D.; Myseros, John S. M.D.; Yaun, Amanda L. M.D.; Keating, Robert F. M.D.

Plastic and Reconstructive Surgery: June 2011 - Volume 127 - Issue 6 - p 2397-2406
doi: 10.1097/PRS.0b013e318213a178
Pediatric/Craniofacial: Original Articles
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Background: The purpose of this study was to critically assess long-term outcomes after open reconstruction of craniosynostosis within the recent decade.

Methods: The authors performed a retrospective, institutional review board–approved review of open repair for craniosynostosis between 1997 and 2009. Surgical factors, complications, and long-term outcomes were assessed. Pearson chi-square, Fisher's exact, and Kaplan-Meier analyses were performed.

Results: Of 212 patients, 72 underwent primary extended synostectomy and 140 had traditional open craniofacial repair. Mean follow-up was 36.3 months (range, 0.5 to 138 months). Indications included sagittal (n = 96), metopic (n = 40), unicoronal (n = 33), bicoronal (n = 24), multisutural (n = 15), bilambdoidal (n = 3), and unilambdoidal (n = 1) synostoses; 8.5 percent of patients were syndromic. Surgical reconstruction was performed at a mean age of 11.3 months (range, 0.2 to 117.8 months), including nonsyndromic patients at an average age of 10.6 months and syndromic patients at age 19.3 months. There were no deaths. A 3.3 percent complication rate included two cerebral contusions, two hematomas, one cerebrospinal fluid leak, one infection, and one wound breakdown. Patients were categorized as 89.2 percent Whitaker class I/II and 10.8 percent Whitaker class III/IV. Major and total reoperation rates were 9.0 percent and 10.8 percent, respectively. Higher total reoperation rate and Whitaker class III/IV distribution significantly correlated with syndromic diagnosis, bicoronal synostosis, and surgical age younger than 6 months.

Conclusions: In this experience of contemporary open craniosynostosis surgery, rates of morbidity, mortality, and reoperation were low. These results support the merits of surgical delay, targeting an age of 6 months or older, and may serve as a more accurate metric of comparison to current minimally invasive techniques for craniosynostosis repair.

Washington, D.C.

From the Department of Plastic Surgery, Georgetown University Hospital, and the Departments of Plastic Surgery and Neurosurgery, Children's National Medical Center.

Received for publication October 25, 2010; accepted December 20, 2010.

Presented at the 55th Annual Meeting of the Plastic Surgery Research Council, in San Francisco, California, May 22 through 26, 2010, and at the 89th Annual Meeting of the American Association of Plastic Surgeons, in San Antonio, Texas, March 20 through 23, 2010.

Disclosures:Dr. Posnick receives royalties for products developed from KLS-Martin and Stryker-Leibinger. The remaining authors have no financial or commercial interests to disclose.

Robert F. Keating, M.D.; Department of Neurosurgery; Children's National Medical Center; 111 Michigan Avenue NW; 4th Floor Main Building; Washington, D.C. 20010; rkeating@cnmc.org

©2011American Society of Plastic Surgeons