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  • Symptomatic Recurrence Following the Open Surgical Repair of Nonsyndromic Craniosynostosis: A Sixteen Year Experience

    Final Number:

    Corey M Mossop

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Recurrence following the open repair of craniosynostosis is a known event that has been described since 1974. However, the prevalence of this complication is poorly reported in the literature. The purpose of this study is to report the prevalence of symptomatic resynostosis following the repair of nonsyndromic craniosynostosis and elucidate any factors associated with this outcome over a sixteen year time period.

    Methods: All nonsyndromic patients undergoing open surgical repair of craniosynostosis between 1997 and 2012 were identified. This population was then examined for symptomatic resynostosis requiring correction in addition to associated factors (such as gender, age at initial surgery, and affected cranial suture[s]). Patients requiring reoperation for other cosmetic issues (such as persistent cranial defects) were not included.

    Results: 257 patients with nonsyndromic craniosynostosis underwent surgical repair at a mean age of 10.9 months (2.2-82.9 months). Fourteen (5.4%) patients required further surgery at an average age of 35.4 months (16.6-93.1 months) for a combination of clinical, cosmetic, radiographic, and ophthalmologic evidence of resynostosis. The average length of time between the initial procedure and subsequent reoperation was 29.0 months (11.6-69.5 months). Patients with bicoronal synostosis were significantly more likely to experience recurrent synostosis (p < 0.05). Additionally, all patients requiring reoperation had an acceptable cosmetic outcome (defined as a Whitaker Class I or II result) with an average follow-up of 6.2 years in this cohort.

    Conclusions: This study of recurrence following open surgical repair of nonsyndomic craniosynostosis represents the largest to date. The prevalence in this study of 5.4% is consistent with prior reports. Given the prolonged time interval between initial surgery and recurrence, long-term surveillance for symptomatic resynostosis up to a decade post-operatively should be highly encouraged. Additionally, parents of patients with nonsyndromic bicoronal synostosis should be informed regarding the increased risk of symptomatic recurrence in this population.

    Patient Care: This study improves patient care by highlighting the need for long-term follow-up to evaluate for symptomatic recurrence of craniosynostosis. Additionally, it illustrates the need for parents of patients with bicoronal synostosis to be aware of the higher recurrence rate in this population.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of symptomatic recurrence of nonsyndromic craniosynostosis and factors associated with its occurrence. 2) Realize the importance of long-term follow-up given the long time frame of recurrence.

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