gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Surgery for craniosynostosis – learning from complications

Kraniofaziale Chirurgie – aus Komplikationen lernen

Meeting Abstract

  • corresponding author H. Collmann - Abteilung Pädiatrische Neurochirurgie, Universitätsklinikum Würzburg
  • H. Böhm - Klinik für MKG-Chirurgie, Universitätsklinikum Würzburg
  • T. Schweitzer - Abteilung Pädiatrische Neurochirurgie, Universitätsklinikum Würzburg
  • J. Krauss - Abteilung Pädiatrische Neurochirurgie, Universitätsklinikum Würzburg
  • N. Sörensen - Abteilung Pädiatrische Neurochirurgie, Universitätsklinikum Würzburg
  • A. Kübler - Klinik für MKG-Chirurgie, Universitätsklinikum Würzburg

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.06.06

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Collmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Analysis of surgical complications and their causative risk factors may assist to improve safety during operative treatment of craniosynostosis.

Methods: Within a 22-year-period 883 patients underwent 976 surgical procedures for craniosynostosis: 341 wide craniectomies, 449 forehead reshapements, and 186 extended cranial vault reconstructive procedures. During this time all surgical complications of any clinical significance were registered prospectively and the presumed causative factors noted.

Results: A total of 40 major complications was encountered: One unexplained fatality, one instance of intraoperative hemorrhagic shock, venous sinus laceration (n=11), postoperative rebleeding (n=4), irreparable dural tears (n=4), cerebral venous infarction (n=1), persistent neurological deficit (n=2), deep wound infection (n=5), local wound breakdown and/or superficial infection requiring surgical repair (n=8), and persistent bone defects necessitating secondary coverage (n=3). Minor complications included dural openings, intraoperative subdural bleedings, minor cortical contusions detected accidentally, perforating wire sutures, and areas of tension alopecia.

Extensive blood loss and laceration of major venous channels were the most threatening adverse events, while the risk of a direct injury to the cranial and orbital contents as well as osteolysis of the devascularized bone segments was obviously quite low.

The main factors precipitating complications appeared to be re-operation, inadequate positioning, abnormal moulding of the inner cranial surface, abnormal venous drainage, severe intracranial hypertension and extended surgical exposure.

Conclusions: Based on our experience typical pitfalls during surgery for craniosynostosis can be defined. In order to minimize the surgical risks, particular guidelines concerning preoperative evaluation, surgical and anaesthesiological strategies, and postoperative management are presented.