Recurrence of Synostosis following Surgical Repair of Craniosynostosis

Background: The incidence of resynostosis after surgical release of synostotic suture(s) is not well reported. The authors examined cases of nonsyndromic and syndromic craniosynostosis treated with surgical repair and established the rate of reoperation for synostosis. Methods: Charts were retrieved from 119 consecutive patients treated for craniosynostosis: 62 percent were boys, and 11 percent were treated for craniofacial dysostosis (Apert syndrome, n = 2; Crouzon syndrome, n = 4; Saethre-Chotzen syndrome, n = 5; and other, n = 2). Results: Eight patients (6.7 percent) underwent surgery for resynostosis [nonsyndromic, six of 106 (5.7 percent); syndromic, two of 13 (15.4 percent)]. Seventy-nine patients (66.4 percent) underwent primary surgery before 1 year of age. Analysis by age at primary operation yielded significantly lower resynostosis rates (p < 0.02) when patients younger than 1 year [two of 79 resynostosis cases (2.5 percent)] were compared with those older than 1 year [six of 40 resynostosis cases (15 percent)]. Further stratifications of age at initial operation did not yield significance for resynostosis. Four of eight patients who resynostosed had raised intracranial pressure, as indicated by lumbar puncture following the primary operation. A trend of increasing mean length of hospital stay, estimated blood loss, and operative time in the patients who eventually resynostosed was observed (data not significant). Conclusions: Resynostosis rates were higher in syndromic than in nonsyndromic children for whom a single suture was involved. Analysis of age at primary operation showed an increase in resynostosis when the primary operation occurred after age 1 year. Evidence of increased intracranial pressure following primary surgery may suggest recurrence.