Craniosynostosis consists of a premature closure of one or more cranial suture. A well known adverse consequence of craniosynostosis surgery is the reoperation. As it is mentioned in literature, reoperations could be due to predictable situations, as in the multistage approach of syndromic synostosis (Crouzon syndrome), or unpredictable events (1). The rate of reoperation outlined in the scientific studies ranges between 7% and 36%(1-4).
Objectives: The aim of our study is to analyze the management of the adverse events in cranio-facial surgery, with particular regard to those complications that led to unplanned reoperation.
Materials & Methods: We reviewed our series of 1188 cases operated by the same surgical team over
a period of 17 years through the data obtained from our Divisional Database.
Data from 398 cases were incomplete, so we excluded from our study. We analyzed 790 patients focusing on complications that led to a second operation and the approach to these unpredictable events.
Results: Out of 790 cases of craniosynostosis we operated on, 7,6% of them were syndromic and 4,1% were not-syndromic non-classifiable multisutural synostosis.
Mortality rate was 0,4% (3 patients out 790). All the mortality cases were syndromic and all died for pulmonary complications. Only in one case the interval between surgery and the death was less than 30 days.
24 patients out 790 (3%) needed at least one unplanned reoperation. 1,3% of single suture, 23% of multisutural synostosis and 15% of syndromic craniosynostosis patients underwent a reoperation (Fig.1). The original surgery was a major procedure in 18 out 24 cases, and a less invasive procedure in 6 out 24
cases.
20 patients needed only 1 reoperation, 2 needed a third surgery and 2 underwent a fourth procedure for a total of 30 procedures.
Complications were faced by our team through dedicated approaches. In some cases the surgical procedure was done in collaboration with maxillo-facial specialists.
Peculiar complications, rarely reported in literature (5), are Growing Fractures: our two cases were treated by dural plasty and autologous cranioplasty reducing both bone defect and dural tear.
Conclusions: Complications in craniofacial surgery are not uncommon, especially in syndromic patients, whose rate is remarkably higher compared to non-syndromic patients (15% vs 2%). We found a clearly increased rate of complication in notsyndromic, non-classifiable, multisutural synostosis compared to single suture craniosynostosis (23% vs 1,3%). Extensive, multi-step surgeries are more keen to complications and reoperations.
Our data were consistent with those found in the litterature (1-4).
Craniosynostosis surgery is, in our opinion, a safe surgery; only 3% of patients underwent an unplanned reoperation. Nonetheless, complications could be difficult to manage and mortality is present in many series.
