Comparative Analysis of Surgical Outcomes in Syndromic Craniosynostosis: Insights from CHOP and CHLA.

Background

This study compares syndromic craniosynostosis treatment approaches of the Children's Hospital of Philadelphia (CHOP) and Children's Hospital Los Angeles (CHLA).

Methods

A retrospective review was performed of patients with Apert, Crouzon, Pfeiffer, Muenke, or Saethre-Chotzen syndromes treated at CHOP or CHLA. Inclusion required treatment according to each institution's respective management algorithms. Primary outcomes were type, timing, and number of craniofacial surgeries.

Results

Sixty-one patients were included. All CHOP patients underwent posterior vault distraction osteogenesis (PVDO) at age 10.2±7.5 months. In the CHLA cohort, 11 (36.7%) underwent early PVDO at 3.9±0.9 months of age, and all underwent fronto-orbital advancement (FOA) at age 9.6±3.3 months. For patients ≥10 years (n=28), the number of major craniofacial procedures in the first 10 years of life was greater in the CHOP cohort (2.3±0.6 vs. 1.8±0.6, p=.023), but the number of frontofacial procedures was fewer (1.2±0.7 vs. 1.7±0.5, p=.044) in comparison to the CHLA cohort. Among those with Apert, Crouzon, and Pfeiffer syndromes, CHOP patients were more likely to undergo midface surgery at a younger age (6.0±1.2 years vs. 7.5±1.5 years, p=.003) via a transcranial approach (61.9% vs. 20.8%, p=.005). Midface distractions were performed using external devices at CHOP and internal at CHLA.

Conclusions

CHOP patients underwent more major craniofacial procedures but fewer frontofacial interventions compared with CHLA patients. CHOP patients with Apert, Crouzon, or Pfeiffer syndromes were more likely to undergo an earlier midface procedure via a transcranial approach. Further investigation is necessary to evaluate the impact of each protocol on outcomes.