Early surgical treatment of nonsyndromic craniosynostosis.
BACKGROUND
Craniosynostosis, a premature fusion of cranial sutures, can happen as an isolated defect (nonsyndromic) or as part of a syndrome. It may lead to raised intracranial pressure and deformity of both the cranial and facial skeletons. Early surgery is usually the best treatment choice. The aim of this study was to review the experience of a multidisciplinary staff with the surgical treatment of nonsyndromic craniosynostosis.


METHODS
All the nonsyndromic craniosynostosis cases treated surgically from 1991 to 2005 at 2 neurosurgical centers were reviewed. The variables analyzed were sex, age, weight, type of deformity, estimated volemia, surgical technique, surgical time, blood loss, PO hospitalization time, and complications. All data were stored in a database and analyzed with Microsoft Access (Microsoft Corp, Seattle, WA) and SPSS V11.0 (SPSS, Inc, Chicago, IL).


RESULTS
The sample consisted of 120 patients (70 males, 50 females). Six patients were excluded because of their atypical timing of treatment (average age, 72 months). The final average age was 7.08 months (variation, 1-18), and the average weight was 7.8 kg. The types of deformities found were scaphocephaly (n = 54, 45%), plagiocephaly (n = 27, 22%), trigonocephaly (n = 19, 16%), brachycephaly (n = 16, 13%), and oxycephaly (n = 4, 3%). The mean surgical time was 186 minutes and the mean PO hospitalization time was 6.8 days. The mortality on this series was 2.6% (3 patients). In the last operated cases, a significant improvement in morbid-mortality was observed.


CONCLUSIONS
A multidisciplinary approach, including neurosurgeons, neurologists, and pediatricians, and appropriate training of the clinical surgical staff can minimize the risks and decrease the complications in the treatment of craniosynostosis, leading to a satisfactory outcome.
Ferreira
Marcelo Paglioli
MP
Neurosurgery Department, Hospital São José/Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre 90020-060, Brazil. marcelopaglioliferreira@hotmail.com
Collares
Marcus Vinícius Martins
MV
Ferreira
Nelson Pires
NP
Kraemer
Jorge Luiz
JL
Pereira Filho
Arthur De Azambuja
Ade A
Pereira Filho
Gustavo De Azambuja
Gde A
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000517:prevention & control; D008297:Male; D011183:Postoperative Complications; D012886:Skull / Q000254:growth & development* / Q000473:pathology*; D016896:Treatment Outcome