gms | German Medical Science

Objective: To evaluate outcome of surgical treatment of craniosynostosis in children over a 20-year period.

Methods: The records of all children with craniosynostosis who presented in our department from 1986 to 2007 were reviewed. Variables analyzed were sex, age, weight, type of deformity, neurological symptoms at presentation, diagnostic methods, surgical technique, blood transfusion, complications and long-term follow-up. All data were stored in a database and statistically analysed.

Results: There were 82 children, 54 boys (65.6%) and 28 girls (34.4%). Mean age at operation was 7.6 months (range from 1.7 to 33.3 months). Average weight was 7.5 kg. Sixty-eight children underwent surgery, and 14 were treated conservatively. Sixty-three cases were nonsyndromic craniosynosthoses and 5 cases were syndromal craniosynostoses (2 Saethre-Chotzen Syndrom, 2 Morbus Crouzon and 1 Dandy-Walker-variant). Major neurological symptoms were delayed development in 12 and signs of increased intracranial pressure in 10 children. The types of deformities found were scaphocephaly (n=30, 47.6%), frontal plagiocephaly (n=16, 25.4%), occipital plagiocephaly (n=1, 1.6%), trigonocephaly (n=12, 19.0%) and brachycephaly (n=4, 6.4%). Forty-two children needed intraoperative blood transfusion (in average 133.6 ml). Complications were postoperative seizure in one patient and wound healing problems in two patients. Four recurrences occurred (2 scaphocephaly, 1 trigonocephaly and 1 frontal plagiocephaly). Overall mortality of the series was 1.6% (1 patient) due to a postoperative bleeding complication. At long-term follow-up unremarkable development equivalent to corresponding normal age groups was seen in all nonsyndromic and in 3 syndromic children. Persistent retardation was observed in two syndromic patients.

Conclusions: Surgical treatment of craniosynostosis in an experienced, interdisciplinary institution provides satisfactory long-term outcome at a relatively low risk.