Surgical treatment of craniosynostosis in infants

OBJECTIVETo compare minimally invasive endoscopic and open surgical procedures, to improve informed consent of parents, and to establish a baseline for further targeted improvement of surgical care, this study evaluated the complication rate and blood transfusion rate of craniosynostosis surgery in our department.METHODSA prospective complication registration database that contains a consecutive cohort of all pediatric neurosurgical procedures in the authors’ neurosurgical department was used. All pediatric patients who underwent neurosurgical treatment for craniosynostosis between February 2004 and December 2014 were included. In total, 187 procedures were performed, of which 121 were endoscopically assisted minimally invasive procedures (65%). Ninety-three patients were diagnosed with scaphocephaly, 50 with trigonocephaly, 26 with plagiocephaly, 3 with brachycephaly, 9 with a craniosynostosis syndrome, and 6 patients were suffering from nonsyndromic multisutural craniosynostosis.RESULTSA total of 18 complications occurred in 187 procedures (9.6%, 95% CI 6.2–15), of which 5.3% (n = 10, 95% CI 2.9–10) occurred intraoperatively and 4.2% (n = 8, 95% CI 2.2–8.2) occurred postoperatively. In the open surgical procedure group, 9 complications occurred: 6 intraoperatively and 3 postoperatively. In the endoscopically assisted procedure group, 9 complications occurred: 4 intraoperatively and 5 postoperatively. Blood transfusion was needed in 100% (n = 66) of the open surgical procedures but in only 21% (n = 26, 95% CI 15–30) of the endoscopic procedures. One patient suffered a transfusion reaction, and 6 patients suffered infections, only one of which was a surgical site infection. A dural tear was the most common intraoperative complication that occurred (n = 8), but it never led to postoperative sequelae. Intraoperative bleeding from a sagittal sinus occurred in one patient with only minimal blood loss. There were no deaths, permanent morbidity, or neurological sequelae.CONCLUSIONSComplications during craniosynostosis surgery were relatively few and minor and were without permanent sequelae in open and in minimally invasive procedures. The blood transfusion rate was significantly reduced in endoscopic procedures compared with open procedures.

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“…Surgical time varies from 4-6 hours. 4 In this way, instantaneous volume increase of the intracranial space is established.…”

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confidence: 99%

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

Arts¹,

Delye²,

Lindert³

2018

Journal of Neurosurgery: Pediatrics

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“…The mean blood loss of 35.4 mL (5.7 mL/kg) was slightly higher than is reported for endoscopic craniosynostosis surgery in literature and so is our blood transfusion rate . The measured blood loss should be considered as an estimated blood loss, since the precise amount of blood loss is hard to determine.…”

Section: Discussionmentioning

confidence: 65%

“…Most of the nasal intubations were performed in patients operated in the sphinx position. In this position, endotracheal intubation via the nasal route has advantages over the oral route, since oral tubes tend to luxate more easily than nasal tubes . This also applies to the brachiocephalic patient since this patient needed to be repositioned during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Beside this, the surgical learning curve could also contribute to this decline. Erb et al stated that excessive blood loss is more common in scaphocephalic patients due to the emissary veins from the sagittal sinus and in trigonocephaly due to the thickness of the frontal bone. Furthermore, they state that patients with a body weight less than 5 kg have a higher risk for blood transfusion, but in this study there was no relevant difference in body weight between the transfused and nontransfused group, respectively 6.1 kg and 6.3 kg.…”

Section: Discussionmentioning

confidence: 99%

“…These procedures have a lesser impact on the pediatric patient and are related with short surgical duration, short length of hospital stay, less blood loss, low blood transfusion rates, and no need for admission to an intensive care unit after surgery . Several centers show positive results regarding their anesthesia technique during the treatment of craniosynostosis . However, most studies are limited to 1 or 2 forms of craniosynostosis, especially sagittal synostosis.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of anesthesia in endoscopic strip craniectomy: A review of 121 patients

Arts

Delye

Lindert

et al. 2018

Pediatric Anesthesia

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SummaryObjective: The aim of this study was to evaluate pre-, intra-, and postoperative anesthetic parameters in endoscopic strip craniectomy in order to improve anesthesiological care. Materials and Methods:This is a retrospective patient cohort study of our first 121 patients treated by endoscopic strip craniectomy. Preoperative as well as intra-and postoperative anesthesiological and neurological parameters were analyzed. Furthermore, the need for intensive care unit admission, blood loss, and blood transfusion rate were measured. Results:The mean age of patients was 3.9 months (standard deviation = 1) at a mean weight of 6.3 kg (standard deviation = 1.3). Comorbidity was registered in 13 (11%) patients of which 5 had syndrome-related comorbidities. Mean duration of anesthesia was 131 minutes (standard deviation = 32) . One hundred and sixteen patients were induced by mask induction with sevoflurane and 5 patients were induced intravenously.In 10 patients, mild intraoperative hypothermia (between 35 and 36 degrees Celsius) occurred. The mean estimated blood loss was 35.4 mL (standard deviation = 28.9) and blood transfusion rate was 21.5%. Brief and small intraoperative oxygen saturation drops were common during this study. No indication for venous air embolism was found based on endtidal CO 2 . Postoperative temperature above 38 degrees Celsius occurred 16 times and benign deviations in postoperative cardiopulmonary parameters occurred in 17 patients. Postoperative pain management was mainly established by paracetamol and low-dose morphine when necessary. No postoperative neurological symptoms were reported and no deaths occurred. Conclusion:These patients had a relatively short intraoperative course with stable vital parameters during surgery. We report a low incidence of significant venous air embolism, a blood transfusion rate of 21% and only minor perioperative disturbances in vital parameters.

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