Craniosynostosis: Optimal Age for Primary Craniofacial Reconstruction and underlying Pathophysiology
Roop Gill, BM, MRCS (Eng), Javier Cifuentes, BA, Marcia Spears, DNP, Kevin Kelly, MD, DDS.
Vanderbilt University, Nashville, TN, USA.
Purpose: Nonsyndromic craniosynostosis has been treated operatively from around the age of 3 months to 1 year without data to support this practice. We examined a consecutive series of nonsyndromic craniosynostosis reconstructions to determine if any perioperative factors were associated with need for reoperation. Additionally we sought to discover if the type of reoperation required could help elucidate the underlying pathophysiology.
Methods: An 11 year retrospective analysis was performed on data collected from 325 consecutive children treated operatively for nonsyndromic craniosynostosis. Perioperative variables including age and suture type were analyzed, comparing them to the incidence and type of reoperation required.
Results: 87 (26.6%) children of the 325 required reoperation. 21 (24%) children required complete revision for early reossification while 57 (66%) children required revision for voids or lack of reossification. Analysis of the data showed that initial surgery at too early a time point was associated with early reossification, and surgery delayed too long was associated with inadequate ossification or voids (full thickness skull defects). The best time for surgery to minimize re-operation was 130 to 240 days (4.3 to 7.9 months), as illustrated in Figure 1. Also suture type was associated with the need for reoperation (p=0.0038), with coronal synostosis and multiple fused sutures having higher rates of reoperation.
Conclusion: Our data indicates that 4 to 8 months is the optimal age for primary reconstruction for craniofacial synostosis, when the skull is most likely to heal without premature reossification or leaving nonossified voids.
Figure 1: Reoperation rate associated with age at first surgery.
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