Recurrence of synostosis following surgical repair of craniosynostosis
Kimberly A Foster1, David M Frim, McKay McKinnon
1Chicago, Ill. From the Sections of Neurosurgery and Plastic and Reconstructive Surgery, University of Chicago, Comer Children's Hospital, and the Pritzker School of Medicine.
Background:
The incidence of resynostosis after surgical release of synostotic suture(s) is not well reported. The authors examined cases of nonsyndromic and syndromic craniosynostosis treated with surgical repair and established the rate of reoperation for synostosis.
Methods:
Charts were retrieved from 119 consecutive patients treated for craniosynostosis: 62 percent were boys, and 11 percent were treated for craniofacial dysostosis (Apert syndrome, n = 2; Crouzon syndrome, n = 4; Saethre-Chotzen syndrome, n = 5; and other, n = 2).
Results:
Eight patients (6.7 percent) underwent surgery for resynostosis [nonsyndromic, six of 106 (5.7 percent); syndromic, two of 13 (15.4 percent)]. Seventy-nine patients (66.4 percent) underwent primary surgery before 1 year of age. Analysis by age at primary operation yielded significantly lower resynostosis rates (p < 0.02) when patients younger than 1 year [two of 79 resynostosis cases (2.5 percent)] were compared with those older than 1 year [six of 40 resynostosis cases (15 percent)]. Further stratifications of age at initial operation did not yield significance for resynostosis. Four of eight patients who resynostosed had raised intracranial pressure, as indicated by lumbar puncture following the primary operation. A trend of increasing mean length of hospital stay, estimated blood loss, and operative time in the patients who eventually resynostosed was observed (data not significant).
Conclusions:
Resynostosis rates were higher in syndromic than in nonsyndromic children for whom a single suture was involved. Analysis of age at primary operation showed an increase in resynostosis when the primary operation occurred after age 1 year. Evidence of increased intracranial pressure following primary surgery may suggest recurrence.
Related Concept Videos
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...
01:03Structural Joints: Fibrous Joints
Suture
All the bones of the skull, except for the mandible, are joined to each other by a fibrous joint called a suture. The fibrous connective tissue found at a suture strongly unites the adjacent skull bones and thus helps to protect the brain and form the face. In...
01:26Aneurysm III: Interprofessional Care
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...