Secondary Cranioplasty After Fronto-Orbital Advancement: Analysis of a National Database

Fronto-orbital advancement (FOA) is the standard treatment for craniosynostosis patients with fronto-orbital dysmorphology. Few studies examine the incidence of secondary cranioplasty operations after FOA. This retrospective analysis utilizes multicenter billing data to identify risk factors and the incidence of secondary reconstructive cranioplasty operations after FOA. A retrospective review was performed on all patients aged 0 to 16 years who underwent primary FOA between 2007 and 2015 in the Pearldriver database. The rates of secondary cranioplasty were analyzed through Current Procedural Terminology (CPT) codes. Cranioplasty with implant and cranioplasty with autograft were identified. Standard statistical analyses were performed. Secondary cranioplasty occurred in 600 (29.6%) of the 2026 patients after primary FOA. Of those, 31.0% underwent implant-based cranioplasty, and 62.7% underwent cranioplasty with an autograft. Secondary cranioplasty occurred in 26.7% of patients who received a primary FOA at ages 0 to 5 years and 75.2% in patients ages 6 to 16 years. Among patients who underwent implant-based cranioplasty (n=186), 28.5% had a skull defect ≤5 cm in diameter and 71.5% had a skull defect >5 cm. Among patients who underwent a cranioplasty with autograft (n=376), 8.8% had a skull defect size ≤5 cm in diameter and 91.2% had a skull defect >5 cm. Secondary reconstructive cranioplasty after FOA to repair large defects (>5 cm) was common. Patients who were older at initial FOA had high rates of secondary cranioplasty, underscoring the importance of timely intervention to harness native dural-based osteogenesis of secondary cranial defects.