Long-Term Outcomes following Craniosynostosis Corrections: A 30-Year Retrospective

Craniosynostosis studies typically focus on perioperative outcomes. Because surgical intervention can negatively affect cranial growth, earlier reviews may overestimate long-term benefit and produce spuriously favorable results. The purpose of this review is to evaluate long-term outcomes following cranial vault remodeling for single-suture craniosynostosis with a focus on skeletal maturity.

A retrospective review was performed of all consecutive patients with single-suture craniosynostosis undergoing remodeling procedures by a single surgeon.

Of 924 reviewed patients, 752 underwent primary and 172 secondary corrections. The median length of stay was 2 days, the allogeneic blood transfusion rate was 7.5%, and the complication rate was 0.7%. Among patients receiving primary repairs, 3.4% underwent secondary correction at a mean age of 5.5 years, with this rate rising to 20% by skeletal maturity. Delaying primary surgical intervention and applying overcorrection were associated with a reduction in the secondary correction rate from 2.2% to 0.6%, despite comparable follow-up durations. The odds ratio suggests that for every month of delay in initial correction, there is an expected 15% reduction in secondary procedures. In a cohort of 835 individuals, gross developmental outcomes fell within the normal range, with only 12% demonstrating mild to moderate delays.

This review of 924 single-suture craniosynostosis remodeling procedures revealed a predominantly benign perioperative course. The overall secondary surgery rate was 3.4%, rising to 20% by skeletal maturity, suggesting that outcomes cannot be fully appreciated until completion of skeletal growth. Focused analyses suggest that delaying primary interventions and performing overcorrections could reduce secondary correction rates. Most of the affected children exhibited developmental trajectories similar to those of unaffected individuals.