+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Complications in the surgical treatment of craniosynostosis and craniofacial syndromes: apropos of 306 transcranial procedures

Complications in the surgical treatment of craniosynostosis and craniofacial syndromes: apropos of 306 transcranial procedures

Child's Nervous System 24(12): 1421-1430

To review the complications in the surgical treatment of craniosynostosis in 306 consecutive transcranial procedures between June 1999 and June 2007. Surgical series consist of 306 procedures done in 268 patients: 155 scaphocephalies, 50 trigonocephalies, 28 anterior plagiocephalies, one occipital plagiocephaly, 20 non-syndromic multisutural synostosis and 32 craniofacial syndromes (11 Crouzon, 12 Apert, seven Pfeiffer and two Saethre-Chotzen) Complications and time of hospitalisation were reckoned. Surgical procedures were classified in 12 different types according to the technique: Type I: frontal-orbital distraction (26 cases); Type II: endoscopic assisted osteotomies in sagittal synostosis (39 cases); Type III: sagittal suturectomy and expansive osteotomies (44 cases); Type IV: same as type III, but including frontal dismantling or frontal osteotomies in scaphocephalies (59 cases); Type V: complete cranial vault remodelling (holocranial dismantling) in scaphocephalies (13 cases); Type VI: frontal-orbital remodelling without frontal-orbital bandeau in trigonocephaly (50 cases); Type VII: frontal-orbital remodelling without frontal-orbital bandeau in plagiocephaly (14 cases); Type VIII: frontal-orbital remodelling with frontal-orbital bandeau in plagiocephaly (14 cases); Type IX: Occipital advancement in posterior plagiocephaly (one case); Type X: Standard bilateral front-orbital advancement with expansive osteotomies (28 cases); Type XI: holocranial dismantling (complete cranial vault remodelling) in multisutural craniosynostosis (12 cases); Type XII: occipital and suboccipital craniectomies in multiple suture craniosynostosis (six cases). There was no mortality and all complications resolved without permanent deficit. Mean age at surgery was 6.75 months. Most frequent complication was non-filiated postoperative hyperthermia (13.17% of the cases) followed by infection (8.10%), subcutaneous haematoma (6.08%), dural tears (5.06%) and cerebrospinal fluid (CSF) leakage (2.7%). Number and type of complications was higher among the group of reoperated patients (12.8% of all): 62.5% of all the series infections, 93% of all dural tears and 75% of all CSF leaks. In relation to surgical procedures, endoscopic assisted osteotomies reported the lowest rate of complications, followed by standard frontal-orbital advancement in multiple synostosis, trigonocephalies and plagiocephalies. Highest number of complications was related to complete cranial vault remodelling (holocranial dismantling) in scaphocephalies and multiple synostoses and after the use of internal osteogenic distractors. Special consideration deserves two cases of iatrogenic basal encephaloceles after combined frontal-facial distraction. Finally, we establish considerations based on the complications related to every specific technique. Percentage and severity of complications relates to the surgical procedure and is higher among patients going for re-operation. Mean time of hospitalization is also modified by these issues.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 052265904

Download citation: RISBibTeXText

PMID: 18769932

DOI: 10.1007/s00381-008-0691-8

Related references

Studies of malformation syndromes of man XXXIX: a craniosynostosis-craniofacial dysostosis syndrome with mental retardation and other malformations: "craniofacial dyssynostosis". European Journal of Pediatrics 123(1): 15-28, 1976

Risk Factors for Postoperative Complications After Surgical Correction of Craniosynostosis: A Nationwide Analysis of 1357 Intracranial Procedures. Plastic and Reconstructive Surgery 136(4 Suppl.): 40-40, 2015

Aesthetic improvement resulting from craniofacial surgery in craniosynostosis syndromes. Journal of Cranio-Maxillo-Facial Surgery 15(4): 189-197, 1987

Indication for and surgical outcomes of the distraction method in various types of craniosynostosis. Advantages, disadvantages, and current concepts for surgical strategy in the treatment of craniosynostosis. Child's Nervous System 20(10): 702-709, 2004

New concepts in the surgical treatment of the craniofacial synostosis syndromes in the infant. Clinics in Plastic Surgery 6(2): 201-226, 1979

Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases. Neurocirugia 19(6): 509-529, 2008

Twenty-year experience with early surgery for craniosynostosis: II. The craniofacial synostosis syndromes and pansynostosis--results and unsolved problems. Plastic and Reconstructive Surgery 96(2): 284-95; Discussion 296-8, 1995

Creating a virtual surgical atlas of craniofacial procedures: Part I. Three-dimensional digital models of craniofacial deformities. Plastic and Reconstructive Surgery 126(6): 2084-2092, 2010

Comments to Esparza et al's article "Surgical treatment of isolated and syndromic craniosynostosis. Results and complications in 283 consecutive cases". Neurocirugia 19(6): 507-508, 2009

Surgical treatment of A and V syndromes. Apropos of 300 cases. Bulletin des Societes d'Ophtalmologie de France 85(5): 561-563, 1985

Surgical treatment complications and lethality of elective and emergency surgical procedures. Lesch, P And R Haering (Ed ) Ulkus: Diagnostik Und Therapie; (Ulcers: Diagnosis And Treatment) 490p Tm-Verlag: Hameln, Germany Illus 369-380, 1990

Results of surgical treatment of alphabetical syndromes in esotropia. Apropos of 98 cases. Journal Francais d'Ophtalmologie 11(12): 825-829, 1988

Complications in 54 frontofacial distraction procedures in patients with syndromic craniosynostosis. Journal of Craniofacial Surgery 26(1): 124-128, 2015

The effects of tissue-non-specific alkaline phosphatase gene therapy on craniosynostosis and craniofacial morphology in the FGFR2C342Y/+ mouse model of Crouzon craniosynostosis. Orthodontics and Craniofacial Research 18(Suppl. 1): 196-206, 2015

Surgical treatment of snoring and sleep apnea syndromes. Results apropos of 59 cases. Annales d'Oto-Laryngologie et de Chirurgie Cervico Faciale 111(7): 393-396, 1994