Craniosynostosis in Africa: Insights from 8 Countries-A Systematic Review and Meta-Analysis.

Abstract

Craniosynostosis is a congenital skull deformity that impacts development and quality of life of children if left untreated. This study aimed to evaluate literature regarding presentation, treatment, and outcomes of craniosynostosis in Africa. A systematic review of the literature using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Fourteen retrospective/prospective studies with 620 patients and 14 case reports involving 27 cases (8 countries) were included. In 12 articles, 56.6% of patients (317/560) were males, with a mean age of 2.4 years (confidence interval [CI]: 1.1-3.7). Abnormal head shape was the most reported presentation in 77.8% of cases (332/427, 8 articles). Syndromic craniosynostosis was seen in 25.2% (CI: 13.7%-36.6%). Common phenotypes were trigonocephaly in 31.5% (CI: 3.6%-59.4%), anterior plagiocephaly in 23.2% (CI: 5.1%-41.3%), and scaphocephaly in 22.1% (CI: 13.5%-30.8%). Five hundred seventy eight patients, 99.5% (CI: 99.0%-100.0%), underwent surgical treatment. Vault remodeling was performed in 72.9% patients (CI: 47.4%-98.6%). Postoperative complications included cerebrospinal fluid leaks 5.4% (CI: 0.0%-11.6%) and surgical site infections 4.5% (CI: 0.0%-10.8%). Follow-up ranged between 0.2 and 40.9 months; 95.6% of cases (CI: 90.1%-100.0%) exhibited improved deformity and neurological deficits at last follow-up. The mortality rate was 3.1% (CI: 0.0%-6.9%, 2 articles). Few studies on craniosynostosis in Africa highlight the need for more research. Treatment with open techniques yields few complications and a low mortality rate. Early diagnosis and collaborative data reporting will enhance understanding of its burden and variations across Africa.