Morbidity Associated with Anterior vs. Posterior Cranial Vault Expansion for early treatment of syndromic craniosynostosis: a systematic review and meta-analysis

Abstract Purpose The purpose of this systematic review and meta-analysis was to estimate and compare rates of unplanned reoperation and complications after undergoing either fronto-orbital advancement (anterior cranial vault expansion) or posterior cranial vault expansion as an early surgery 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 the time of electronic publication 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 as an early surgery. 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. Anterior cranial vault expansion 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. Conclusions Both anterior and posterior approaches are suitable options in the treatment of syndromic craniosynostosis depending on patient specific factors. Anterior cranial vault expansion was associated with higher rates of unplanned reoperation and complications when compared to posterior techniques in this analysis. Due to the paucity of literature which met inclusion criteria, this study was not able to assess critical outcome variables such as distance distracted/volumetric expansion, estimated blood loss, and cost. Larger studies evaluating both techniques under multiple institutions with long-term follow-up are indicated.