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Does the incidence of traumatic brain injury in children increase after craniofrontal surgery?
Mirko S Gilardino1, Shareef Jandali, Linton A Whitaker
1Montreal Children's Hospital, McGill University Health Center, Montreal, Canada. mirko.gilardino@muhc.mcgill.ca
Insights
Craniofrontal reshaping (CR) surgery for craniosynostosis does not significantly increase the risk of traumatic brain injury (TBI). The study found an extremely low incidence of TBI in patients following this procedure.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Craniosynostosis requires craniofrontal reshaping (CR) surgery, which temporarily compromises skull integrity.
- A potential concern is an increased risk of traumatic brain injury (TBI) post-CR.
Purpose of the Study:
- To investigate the incidence of TBI in patients after craniofrontal reshaping for craniosynostosis.
Main Methods:
- Retrospective chart review of 396 patients who underwent CR between 1997-2007.
- TBI defined as CT-documented injury or loss of consciousness within 2 years post-surgery.
- Exclusion criteria included age >1 year at surgery or <2 years follow-up.
Main Results:
- Zero cases of TBI were recorded in the study cohort.
- The incidence of TBI was 0 per 100,000 patients (95% CI, 0-760/100,000).
Conclusions:
- The risk of TBI after craniofrontal reshaping surgery for craniosynostosis is extremely rare.
- While a theoretical risk exists during skull healing, the absolute incidence remains very low.
Background:
Craniofrontal reshaping (CR) for the treatment of craniosynostosis results in a temporary cranial defect due to the advancement and/or expansion of the supraorbital and frontal bones. The goal of the present study was to determine whether the incidence traumatic brain injury (TBI) was increased in patients after CR as a result of this breach in skull integrity.
Methods:
We performed a retrospective chart review of all patients with a diagnosis of craniosynostosis who underwent CR between 1997 and 2007 at our institution. The incidence of TBI (defined as a computed tomography-documented brain or skull injury or loss of consciousness) was determined during a 2-year postoperative follow-up period. Patients older than 1 year at the time of surgery, or those with less than 2 years of follow-up after surgery, were excluded.
Results:
A total of 396 patients met the inclusion criteria. The incidence of TBI was zero (95% confidence interval, 0-760/100,000).
Conclusions:
The estimated incidence of TBI after CR surgery is between 0 and 760 per 100,000 patients in our clinic population. These data indicate that although CR may be associated with a slightly increased risk of TBI while the skull is healing, the absolute incidence of such injury remains extremely rare.
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