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044. Morbidity Associated with Fronto-Orbital Advancement Versus Posterior Cranial Vault Expansion for Early Treatment of Syndromic Craniosynostosis: a Systematic Review and Meta-Analysis

Authors: Matthew Jacob Recker, MD

Introduction:
The choice of initial surgical intervention for patients with syndromic craniosynostosis is dictated by patient specific factors as well as surgeon and center preference. When minimally invasive techniques are not feasible, open expansion of either the anterior or posterior cranial vault can be utilized. The purpose of this systematic review and meta-analysis was to compare rates of unplanned reoperation and complications after undergoing either anterior or posterior cranial vault expansion in the management of syndromic craniosynostosis.Methods: A literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified in 2 electronic databases (PubMed and EMBASE) from January 1964 to November 2020. Quality assessment and risk of bias were appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. A meta-analysis was performed comparing rates of reoperation and complications between subjects who underwent anterior or posterior cranial vault expansion.
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. Fronto-orbital advancement was associated with significantly higher rates of reoperation (Peto OR = 2.83; 95% CI = 1.19, 6.74, P = 0.02) and complications (Peto OR = 2.61; 95% CI = 1.12, 6.12, P = 0.03) when compared to posterior cranial vault expansion.
Conclusion:
Anterior and posterior surgical approaches for cranial vault expansion in patients with syndromic craniosynostosis are both reasonable treatment options. Meta-analysis of the included studies suggests posterior approaches are associated with lower overall rates of unplanned reoperation and complications when compared with anterior approaches.