AAPS Main SiteA Comparative Analysis Of Complications Associated With Intracranial Procedures In 746 Patients With Non-syndromic Single Suture Craniosynostosis
Youssef Tahiri, MD, J. Thomas Paliga, BA, Ari M. Wes, BA, Linton A. Whitaker, MD, Scott P. Bartlett, MD, Jesse A. Taylor, MD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Purpose
Within the diagnosis “craniosynostosis”, there is a subset of patients who present with isolated, non-syndromic, single suture involvement. Considering these patients together with syndromic patients, or with all patients who undergo trans-cranial craniofacial surgery, may convey an inaccurate view of risk. This study evaluates the early and late complications of patients with non-syndromic, single suture craniosynostosis throughout the evolution of treatment at a single institution.
Methods
An IRB-approved retrospective chart review was performed on consecutive patients undergoing correction of single suture synostosis from May 1978 to January 2013 at a large tertiary pediatric care center. Inclusion criteria required a diagnosis of single suture cranioynostosis and complete medical record. Patients were excluded for previous interventions at other institutions or diagnosis of syndromic or multisutural craniosynostosis. Demographic information, operative details, and post-operative course were collected. Complications were categorized as either “major” (requiring additional intervention) or “minor” (not requiring surgical intervention). Reoperations solely due to complications were also included in the analysis. Chi-squared and Fisher’s exact test were used to compare all categorical variables.
Results
From 1978 to 2012, 746 patients underwent surgical correction of non-syndromic craniosynostosis. Of these, there were 307(41.2%) sagittal, 201(26.9%) metopic, and 238(31.9%) unicoronal. There were 31 surgical complications (4.15%). Six were considered major including one post-operative mortality in a patient with hypoplastic left heart syndrome, and two and three reoperations for post-operative hematoma and post-operative infection, respectively. Minor complications occurred in 25(3.35%) patients and included hematoma (n=4), seroma (n=5) and superficial wound infection (n=5). Infections reported were solely surgical site infections (SSI), including 4, 2 and 2 cases in sagittal, metopic and unicoronal synostosis respectively. Any child who presented with single suture synostosis had an overall risk of CSF leak of 0.13%, SSI of 1.07%, hardware related complications of 2.28%, and mortality of 0.13%. Suture involvement was not significantly associated with the complication rate (p=0.06). A child with isolated SSS and any comorbidity had a significantly greater risk of any complication (p=0.037, OR=2.28), and specifically an increased risk of surgical complication (p=0.05, OR=2.38).
Conclusions
These data represent the largest complications evaluation of non-syndromic, single suture synostosis treatment to date. We characterize the complications and reoperation rates in this population of patients, demonstrating statistically lower risk for those patients without additional co-morbidity. These data allow us to counsel families more accurately with regards to morbidity and mortality associated with this select group of patients.
Table 1. Patients demographics and interventions.
| Sagittal | Metopic | Unicoronal | |
| Mean age at initial surgery (yrs) | 1.1 +/- 1.4 | 0.8 +/- 0.4 | 1.1 +/- 1.9 |
| Gender | |||
| Male | 236 | 144 | 78 |
| Female | 71 | 57 | 160 |
| Type of procedure | |||
| Bilateral FOA | 30 | 201 | 10 |
| Unilateral FOA | 0 | 0 | 228 |
| Sagittal strip craniectomy (Mid vault) | 214 | 0 | 0 |
| Spring cranioplasty | 11 | 0 | 0 |
| Total Vault remodeling | 12 | 0 | 0 |
| Posterior vault remodeling | 40 | 0 | 0 |
Table 2. Medical comorbidities
| Sagittal | Metopic | Unicoronal | |
| Cardiovascular | 2 | 17 | 1 |
| Craniofacial | 0 | 12 | 2 |
| Respiratory | 0 | 2 | 1 |
| Extremity | 2 | 3 | 0 |
| Endocrine | 2 | 2 | 1 |
| CNS/PNS | 1 | 7 | 5 |
| GI/GU | 0 | 12 | 1 |
| Total | 7 | 55 | 11 |
Table 3. Complications in patients with and without comorbidities.
| No Comorbidity | Comorbidity | P | OR | ||
| All Complications | 30 | 9 | 0.037 | 2.28 | |
| Surgical | 22 | 7 | 0.05 | 2.38 | |
| Medical | 8 | 2 | 0.36 | - | |
| CSF Leak | 1 | 0 | 1 | - | |
| SSI | 4 | 1 | 0.487 | - | |
| Hardware Complication | 15 | 2 | 1 | - | |
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