Article
Long-term reoperation rate after correction of non-syndromic craniosynostosis
Langzeit-Reoperationsrate nach operativer Korrektur nicht-syndromaler Kraniosynostosen
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Authors
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Thomas Beez
- Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Hendrik-Jan Mijderwijk
- Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Christopher Munoz-Bendix
- Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Majeed Rana
- Universitätsklinikum Düsseldorf, Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Düsseldorf, Deutschland
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Daniel Hänggi
- Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: Potential reasons for delayed reoperation after correction of non-syndromic craniosynostosis are raised intracranial pressure and suboptimal aesthetic outcome. In addition to the early complication/reoperation rate (e.g. due to surgical site infection), the long-term reoperation rate significantly contributes to overall morbidity. Here we provide the results of a systematic literature review.
Methods: A comprehensive systematic literature search was performed on PubMed, Web of Science and Google Scholar for studies reporting late reoperation rate (>30 days after initial surgery) for children with non-syndromic craniosynostosis undergoing open or endoscopic surgery. The search results were reviewed according to PRISMA methodology and finally 14 studies were included, with sample sizes ranging from 15 to 500 patients. Descriptive statistics were performed using Prism 9.0 (GraphPad Software, USA).
Results: The pooled analysis comprises 1,824 patients, with 55% (N=998) being treated with open surgical correction and 45% (N=826) with endoscopic strip craniectomy and adjuvant molding helmet treatment. The overall reoperation rate was 13.5% and 10.6% (NS), respectively. Among 10 studies reporting reoperation rates for open surgery, 9 studies described raised intracranial pressure (ICP) as the reason for delayed reoperation, and only 1 study described reoperation for resynostosis without specifying ICP (N=5). Among 4 studies on endoscopic surgery, only 1 study explicitly stated raised ICP as the reason for reoperation (N=6), whereas 2 publications stated reoperation for resynostosis (N=9) or unclear reason (N=15). Overall delayed reoperation rates ranged from 0.95% to 40%, indicating relevant heterogeneity across the studies. Risk of bias analysis revealed significant potential bias.
Conclusion: In children with non-syndromic craniosynostosis the rate of delayed reoperation is 13.5% for open and 10.6% for endoscopic surgery. The main indication for reoperation in published studies is raised intracranial pressure, although pooling of data is hampered by bias, missing information and variable definitions (e.g. measured versus symptomatic raised ICP). Based on the available literature, the long-term reoperation rate after correction of non-syndromic craniosynostosis appears to be independent of the surgical treatment modality.
