The Optimal Timing for Primary Cranial Vault Reconstruction in Nonsyndromic Craniosynostosis

There is a lack of consensus on the optimal timing for primary cranial vault reconstruction in cranial synostosis. The purpose of this study was to assess the impact of age at primary reconstruction on the need for revision surgery in nonsyndromic craniosynostosis. A retrospective review was conducted on all children undergoing cranial vault reconstruction for nonsyndromic craniosynostosis during a 10-year period. Demographics and length of follow-up was collected for each patient. Complications, mortality, need for reoperation, and type of reoperation were recorded. Reoperations were classified as total reoperations for premature reossification, voids and recontouring, just voids, and minor procedures. In total, 325 consecutive patients were included with an average length of follow-up of 3.3 years. The authors' complication rate was 11.1%, total reoperation rate was 26.8%, with zero mortalities. Sex and race did not impact the reoperation rate. Multiple suture synostoses were associated with increased risk of reoperation. A regression analysis showed that the lowest risk of reoperation occurred at an age of 200 days, with the 95% confidence interval of hazard ratios falling between 4 months and 8 months of age. Operation at earlier ages was associated with higher risk of reoperation for reossification, while operating at later ages was associated with higher risk for revision surgery to fill voids. Based on authors' institution's 10-year experience, authors' results suggest that the optimal timing for primary cranial vault reconstruction in nonsyndromic craniosynostosis is between 4 and 8 months. This operative window is associated with the lowest risk for revisionary surgery.