Surgical Management of Craniosynostosis

Background: Craniosynostosis is defined as the premature closure of one or more of the sutures normally separating the infant s skull bony plates, causing abnormal growth of the cranial vault and skull base, which may affect brain growth and development. The management of craniosynostosis varies widely with no consensus on the optimal timing or type of surgical intervention. Treatment varies depending upon patient’s age at presentation, type of synostosis, and the severity of its deformity, and ultimately the surgical team’s preferences. Objective: Aim of this study is to assess the peri-operative complications and operative outcome of the surgical treatment of craniosynostosis. Patients and Methods: Retrospective analysis of the medical records of twenty three patients operated for craniosynostosis. Results: The average age: 9.3±4 months; range: 4-19 month. The follow-up ranged from 1 year to four years (median: 32 months). Cranial vault remodeling was performed in all patients; while orbital advancement was performed additionally in four patients (17.4%). The mean operative time was 169±40 minutes. Postoperative hospitalization averaged of 5.8 days. The mean intraoperative blood loss was 37.5% of the estimated blood volume for age. Operative and postoperative complications were observed in six patients (26.1%); three cases (13%) suffered hypovolemic shock during surgery. A dural tear, extradural hematoma and wound infection each in a patient. All patients had improvement of their preoperative cosmetic status. Conclusion: Performing aggressive cranial or cranio-orbital remodeling provides the best cosmetic results, it should better be performed after sixth month of age to reduce any anticipated morbidity and not be delayed beyond the first year of life if a good cosmetic outcome is desired.