gms | German Medical Science

Objective: To evaluate the neurological and aesthetic outcome of children operated over a 15-year-period due to craniosynostosis, to assess the optimum time period for operative treatment.

Methods: A retrospective chart review of 121 patients operated between February 1984 and October 2000. Data included age at the time of operation, perioperative complications, duration of hospital stay, intraoperative blood loss, transfusion, neurological outcome, skull growth after operation, and the aesthetic outcome evaluated 6 months and 18 months after the operation by parents and the treating medical doctors.

Results: The ratio boy:girl was 3:1. The mean age was 5 months. 81 children (67%) suffered from sagittal synostosis, 22 children (18%) from metopic synostosis, 13 cases (11%) from coronal synostosis, 5 children (4%) from lambdoidal synostosis. 97.6 % of the children had an uneventful postoperative course. The aesthetic outcome was assessed through a standardized evaluation form 6 months and 1 year after operation by the treating medical doctors and the parents. The surgical team was excluded from the evaluation. The comparison of the two groups (parents/pediatricians) was highly significant (p<0.001) and showed only little divergence in the evaluation, indicating that parents and pediatricians had a highly convergent opinion on the aesthetic outcome. 57% presented with a complete symmetrical skull shape, thus presenting the optimal postoperative result. 9% presented with a discrete asymmetry of the skull surface. 17% had a discrete skull asymmetry. 7% had an apparent skull asymmetry, 10% presented with an unsatisfactory result. 2 children were re-operated because of the unsatisfactory postoperative result.

Conclusions: The treatment of craniosynostosis remains a challenge in today’s medicine. Our results suggest, in accordance with results of other authors, that the optimum time period for the craniofacial correction lies between the 6^th and 12^th month. During this period the children are mature enough to tolerate the operation well and the skull bone is more stable. Through the operative treatment, the deficit of skull growth and the resulting functional disorder can be corrected to a high degree. But the pathology has to be seen as a dynamic process so that, in the further course, a second operative correction is not always avoidable. The risk for perioperative complications is low in non-syndromic craniosynostosis. Longtime follow-ups and a thorough documentation of all parameters are crucial for the improvement of treatment.