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Prior fronto-orbital advancement associated with complications from transcranial midface surgery in patients with syndromic craniosynostosis

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Abstract

Purpose

Our center adopted posterior vault distraction osteogenesis (PVDO) as a first-line intervention for cranial expansion in syndromic craniosynostosis in 2008, and we have a growing cohort of patients undergoing transcranial midface advancement who have not had prior fronto-orbital advancement (FOA). The purpose of this study was to evaluate whether a history of FOA influences the risk profile of transcranial midface advancement in patients with syndromic craniosynostosis.

Methods

Patients undergoing transcranial fronto-facial advancement from 2000 to 2022 were retrospectively divided into cohorts based on preceding history of fronto-orbital advancement (FOA− and FOA+). Perioperative outcomes including operative time, length of stay, intraoperative dural injury, and complications (Clavien-Dindo score) were compared between groups with appropriate statistics.

Results

Thirty-eight patients were included (15 in FOA− group and 23 in FOA+ group). The overall complication rate was 47% (10% minor, 37% major). Compared to the FOA− group, the FOA+ group had a higher incidence of dural tears (65% v 20%, p = 0.006) and major complications (48% v 13%, p = 0.028). These findings were recapitulated in multivariate logistic regression controlling for other predictors.

Conclusions

Prior FOA is associated with increased rates of major complications and dural tears in patients with syndromic craniosynostosis undergoing fronto-facial surgery. Options for cranial vault expansion that avoid the frontal region, such as PVDO, may favorably alter the risk profile of fronto-facial advancement.

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Availability of data and materials

The data generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Division of Plastic, Reconstructive, and Oral Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA

    Connor S. Wagner, Matthew E. Pontell, Michaela K. Hitchner, Carlos E. Barrero, Lauren K. Salinero, Jordan W. Swanson, Scott P. Bartlett & Jesse A. Taylor

Authors
  1. Connor S. Wagner
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  2. Matthew E. Pontell
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  3. Michaela K. Hitchner
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  4. Carlos E. Barrero
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  5. Lauren K. Salinero
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  6. Jordan W. Swanson
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  7. Scott P. Bartlett
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  8. Jesse A. Taylor
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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Connor S Wagner, Matthew E Pontell, and Michaela Hitchner. The first draft of the manuscript was written by Connor S. Wagner, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Jesse A. Taylor.

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Ethics approval and consent to participate

This study was approved by the Institutional Review Board at the Children’s Hospital of Philadelphia.

Conflicts of interest

Dr. Taylor Co-Owner of Ostiio LLC. Dr. Swanson has received educational grants from KLS Martin and developed educational content for Depuy Synthes/Johnson and Johnson.

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Wagner, C.S., Pontell, M.E., Hitchner, M.K. et al. Prior fronto-orbital advancement associated with complications from transcranial midface surgery in patients with syndromic craniosynostosis. Childs Nerv Syst 39, 1619–1626 (2023). https://doi.org/10.1007/s00381-023-05879-3

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  • DOI: https://doi.org/10.1007/s00381-023-05879-3

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