D53. Risk Stratification of Transcranial Midface Advancement in Patients with Syndromic Craniosynostosis: 20-year Institutional Experience

Abstract

PURPOSE: Monobloc frontofacial advancement and multi-piece midfacial osteotomies such as facial bipartition have profound benefits for patients with syndromic craniosynostosis but also carry the highest published potential for morbidity. Owing to rarity of these procedures, it has been difficult to assess whether perioperative morbidity is evenly distributed across surgical candidates, or rather, if certain patient factors portend increased risk. This study utilized a long-term institutional experience to reevaluate the risk profile of transcranial midface advancement. METHODS: Patients undergoing transcranial frontofacial advancement from 2000-2022 were included. Prior surgical history was recorded, as were perioperative characteristics including minor (surface infection, seroma) and major complications (infection requiring reoperation, CSF leak) graded on the Clavien-Dindo scale. Factors predicting complications were assessed with univariate and multivariate statistics. RESULTS: Thirty-seven patients were included. The complication rate from transcranial midface advancement was 49% (11% minor, 38% major). Predictors of major complications included history of tracheostomy (p = 0.012), prior fronto-orbital advancement (FOAR) (p = 0.021), and age at surgery (p = 0.035). Prior FOAR was the sole predictor of intraoperative dural injury (p = 0.020). Multiple logistic regression identified age at surgery (p = 0.021) and preoperative tracheostomy (p = 0.035) as predictors of major complications. CONCLUSION: This study presents key predictors of morbidity after transcranial midface advancement in patients with syndromic craniosynostosis, namely presence of a tracheostomy, history of prior FOAR, and older age. This is important information for surgeons and families, alike, providing surgeons with targets for risk reduction and families with appropriate risk stratification.