Complications of Therapies for Nonsyndromic Craniosynostosis in Children

  • Hyponatremia: Hyponatremia is common. The etiology is that of cerebral salt wasting rather than SIADH. Isotonic solutions should be administered pre-, intra-, and postoperatively. The patient must be kept normovolemic. The hyponatremia corrects without intervention (10, 31).
  • Seizures: The incidence of seizures has been documented to be 12.9% in the nonsyndromic and 11.8% in the syndromic craniosynostosis populations (27, 35). The author finds these incidences high since her institution has not had a patient with a recognized seizure in 12 years.
  • Infection: Infection rates are about12.5%. Eighty-five percent of these occur at second surgery. No infections are observed in children under the age of 13 months. Not shaving the hair did not increase the infection risk (19).
  • Air embolism: One case of air embolism has been reported in a patient undergoing open surgery and one in a patient undergoing an endoscopic procedure (27, 47).
  • Hydrocephalus: Hydrocephalus and increased ICP are found in 12.1–42.1% of children with syndromic synostosis versus 0.3–3.8% in children with nonsyndromic synostosis (11, 35).
  • Leptomeningeal cyst: A leptomeningeal cyst was found in a patient undergoing endoscopic craniosynostosis repair (3).
  • Intracranial injury: Intracerebral hematoma and contusion were demonstrated in 4 of 212 patients undergoing craniosynostosis repair (53).
  • CSF leak: A CSF leak was observed in 1 of 212 patients undergoing craniosynostosis (53).