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Long-term Outcomes Following Craniosynostosis Corrections, A Thirty-Year Retrospective
Demetrius Coombs, MD1, Kanlaya Ditthakasem, M.N.S., R.N.
2, Morley Herbert, PhD
2, Jeffrey A. Fearon, M.D.
1.
1The Craniofacial Center, Dallas, TX, USA,
2Department of Clinical Research, Medical City Dallas Hospital, Dallas, TX, USA.
PURPOSE: Craniosynostosis studies typically concentrate on perioperative outcomes. Since surgical interventions negatively impact growth, the earlier reviews are implemented, the more likely to suggest spuriously encouraging results. The purpose of this review was to evaluate long-term outcomes following remodeling corrections for single-sutural craniosynostosis with a focus on skeletal maturity.
METHODS: A retrospective review was performed of all consecutive patients with single-sutural craniosynostosis undergoing remodeling procedures by a single surgeon.
RESULTS: Of 924 reviewed patients, 752 underwent primary and 172 secondary corrections. The median length of stay was 2 days, the allogeneic blood transfusion rate was 7.5%, and the complication rate was 0.7%. Among primary repairs, 3.4% underwent secondary corrections at a mean age of 5.5-years; with this rate rising to 20% by skeletal maturity. Delaying primary surgical interventions and over-correcting, saw redo rates, with equal lengths of follow-up, drop from 2.2 to 0.6%. An odds ratio suggests for every month initial corrections are delayed one could expect a 15% reduction in secondary procedures. As assessed in 835 individuals, gross developmental levels fell within the normal range, with only 12% demonstrating mild-to-moderate delays.
CONCLUSION: This review of 924 single sutural craniosynostosis remodeling procedures revealed a predominantly benign perioperative course. The overall secondary surgery rate was 3.4%, rising to 20% by skeletal maturity, suggesting outcomes cannot be fully appreciated until completion of skeletal growth. Focused analyses suggest delaying primary interventions and performing over-corrections could reduce redo rates. Lastly, most affected children appear to possess a developmental spectrum not dissimilar from unaffected individuals.
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