Epidemiologic and Surgical Approach of Cranyosynostosis: A Case of Madagascar and Review of Literature

Abstract

Introduction: Craniosynostosis is a premature closure of one or more sutures of the skull. She reaches 1 child out of 2100. She is responsible for a psychomotor developmental delay. The objective of this study was to define epidemiology, surgical approach and compare with literature.
 Methods: this was a multicenter retrospective descriptive study performed in hospitalized children operated or not on three neurosurgery centers (CHU-JRA, CENHOSOA and Fianarantsoa), from January 2010 to December 2017. Variables studied: epidemiology, clinical, paraclinical and therapeutic.
 Results: During the targeted period, 52 children had craniosynostosis (4 cases at CENHSOA, 6 at Fianarantsoa and 42 at CHUA-HJRA). There was a clear male predominance with a sex ratio of 2.4. The average age was 13.11 months. Several types of craniosynostosis were reported, the majority of which were dominated by brachycephaly in 40.38% followed by scaphocephalia (21.15%) and 2 cases of Apert Syndrome. The main symptom was delayed psychomotor development (34.46%). A standard radiography of the skull required in 76.92% and a scanner in 15.38% of the cases. The average age at surgery was 13.04 months. The majority of the surgical techniques practiced were a suturotomy, with blood transfusion and the majority of which at the time of the incision.
 Conclusion: Craniosynostosis is a pathology that requires neurosurgical management. Several operative techniques exist but the indication depends on the age and the clinico-radiological aspect of the pathology. The main cause of death is related to intraoperative bleeding.