Surgical Treatment of Craniosynostosis: Outcome Analysis of 250 Consecutive Patients

Abstract

ABSTRACT. Objective. Surgery for craniosynostosis has evolved rapidly over the past two decades, with increased emphasis on early, extensive operations. Older published series may not accurately reflect more recent experience. Our study was designed to analyze outcome in a large series of consecutive patients treated recently at a single center.Methods. We reviewed 250 consecutive patients who underwent surgical treatment of craniosynostosis between January 1, 1987 and December 31, 1992. They were divided into nine groups by suture involvement: sagittal, unilateral coronal, bilateral coronal, unilateral lambdoid, bilateral lambdoid, metopic, multiple suture, the Kleeblattschädel deformity (cloverleaf skull), and acquired craniosynostosis. Outcome was analyzed in terms of residual deformities and irregularities, complications, mortality, as well as the need for additional surgery.Results. There were 157 males (62.8%) and 93 females (37.2%), with most of the male preponderance accounted for by the large sagittal synostosis group, which consisted of 82 males and 25 females. Median age at first operation was 147 days. A named syndrome was present in 23 patients (9.2%) and was more common than expected with bilateral and unilateral coronal synostosis, the Kleeblattschädel deformity, and multiple suture synostosis. There were two deaths (0.8%), both with Kleeblattschädel patients, and 17 other complications (6.8%). Morbidity and mortality were significantly associated with secondary vs primary operations and syndromic vs nonsyndromic patients. Outcome analysis revealed the best surgical results with metopic synostosis and significantly less good results with the Kleeblattschädel deformity, multiple suture synostosis, and bilateral coronal synostosis.Conclusions. Using modern surgical techniques, craniosynostosis can be corrected with good outcomes and relatively low morbidity and mortality, particularly for otherwise healthy, nonsyndromic infants. Pediatrics 1997;100(1). URL: http://www.pediatrics.org/cgi/content/ full/100/1/e2; craniosynostosis, craniofacial anomalies, craniofacial surgery, facial deformities.

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

“…The global results of our patients are quite similar to those of other reported series 29,30,41 consisting of 85.5% of good final results and 15.5% of poor outcomes. Craniofacial syndromes accounted for 6.36% of these poor results, 2.12% corresponded to anterior plagiocephaly and 1.76% to non-syndromic craniosynostosis.…”

“…Reported mortality rates in the current literature on craniofacial surgery are very low 41 . Fortunately, we experienced only 2 deaths in our series that occurred 1-year after the initial treatment, although the basal encephalocele of the patient with Pfeiffer's syndrome was deemed as a severe complication of our treatment.…”

“…Nevertheless, some problems regarding treatment of craniosynostosis still remain unanswered 6,22,30,37 . Although some reports have addressed the global results of craniosynostosis management 16,17,41 , most of them are from the last decade of the 20 th century 29,30,41 and, in our opinion, they are not sufficient to establish a universal accepted algorithm of treatment. The scarcity of available publications dealing with complications is also surprising.…”

“…The scarcity of available publications dealing with complications is also surprising. In addition, most of them are included in clinical series regarding general aspects of the craniosynostoses 16,41,[44][45][46] or dealing with postoperative infection 13,25,48 .…”

Precision and error of three‐dimensional phenotypic measures acquired from 3dMD photogrammetric images

“…Whether analyzed in a model system or in the human population at large, quantitative studies of phenotypic variation at various points in ontogeny are needed to complete our understanding of the effects of known genetic factors and to uncover the influence of those not yet known to us. Modern geometric morphometric methods are available for the analysis of 3D phenotypic data sets [e.g., Marcus et al, 1996;Richtsmeier et al, 1992;Richtsmeier et al, 2002] and more traditional methods of morphological analysis have already proven extremely valuable in explanation of the genotype-phenotype continuum [e.g., Darvasi, 1998;Falconer and Mackay, 1996;Flint and Mott, 2001;Lynch and Walsh, 1995], and in the assessment of surgical outcome [e.g, Sloan et al, 1997]. 3D photogrammetry, when used appropriately and in an informed manner, is one means for acquiring large amounts of accurate phenotypic data in relatively short periods of time in the interest of adding to this growing body of information.…”