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Morbidity Associated With Anterior Versus Posterior Cranial Vault Expansion for Early Treatment of Syndromic Craniosynostosis: A Systematic Review and Meta-Analysis

  • Ian J. Richardson
    Affiliations
    Resident, Department of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Louisiana State University, New Orleans, LA; Former predoctoral student, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY
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  • Lauren E. Wager
    Affiliations
    Resident, Department of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, University of Florida, College of Medicine- Jacksonville, Jacksonville, FL; Former predoctoral student, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY
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  • Matthew J. Recker
    Affiliations
    Resident in training, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
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  • Renée Reynolds
    Affiliations
    Assistant professor and Residency Program Director, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
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  • Ramon Ruiz
    Affiliations
    Director, Pediatric Craniomaxillofacial Surgery, Arnold Palmer Hospital for Children, Orlando, FL
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  • Michael R. Markiewicz
    Correspondence
    Address correspondence and reprint requests to Dr Markiewicz, Department of Oral and Maxillofacial Surgery, University at Buffalo, 3435 Main St, 112 Squire Hall, Buffalo, NY 14214
    Affiliations
    Professor and Chair, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, Clinical Professor, Department of Neurosurgery, Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Attending Surgeon, Roswell Park Comprehensive Cancer Center, Co-Director, Craniofacial Center of Western New York, John Oishei Children's Hospital, Buffalo, NY
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Published:November 12, 2021DOI:https://doi.org/10.1016/j.joms.2021.10.022

      Purpose

      The purpose of this systematic review and meta-analysis was to estimate and compare rates of unplanned reoperation and complications after undergoing either fronto-orbital advancement (anterior cranial vault expansion) or posterior cranial vault expansion as an early surgery in the management of syndromic craniosynostosis.

      Materials and Methods

      A literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant articles were identified in 2 electronic databases (PubMed and EMBASE) from the time of electronic publication to November 2020. Quality assessment and risk of bias were appraised using the Grading of Recommendations Assessment, Development and Evaluation system. A meta-analysis was performed comparing rates of reoperation and complications between participants who underwent anterior or posterior cranial vault expansion as an early surgery.

      Results

      Of 1,373 screened records, 7 met inclusion criteria. Six were included in the meta-analysis. The studies that met inclusion criteria reported on 103 patients treated with anterior techniques and 72 patients treated with a posterior approach. Anterior cranial vault expansion was associated with significantly higher rates of reoperation (Peto odds ratio = 2.83; 95% confidence interval = 1.19, 6.74, P = .02) and complications (Peto odds ratio = 2.61; 95% confidence interval = 1.12, 6.12, P = .03) than posterior cranial vault expansion.

      Conclusions

      Both anterior and posterior approaches are suitable options in the treatment of syndromic craniosynostosis depending on patient-specific factors. Anterior cranial vault expansion was associated with higher rates of unplanned reoperation and complications than posterior techniques in this analysis. Because of the paucity of literature which met inclusion criteria, this study was not able to assess critical outcome variables such as distance distracted/volumetric expansion, estimated blood loss, and cost. Larger studies evaluating both techniques under multiple institutions with long-term follow-up are indicated.
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