Venous Air Embolism During a Craniofacial Procedure

Phillips, R; Mulliken, John B.

doi:10.1097/00006534-198882010-00029

Cited by 48 publications

(6 citation statements)

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“…Several published studies have reported neurological complications related to cranial vault reconstruction surgical procedures, including intracranial hemorrhages 21,[28][29][30][31] and venous infarcts. 30 Therefore, patients require close monitoring after cranial vault reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Utility of Routine Computed Tomography Scans after Cranial Vault Reconstruction for Children with Craniosynostosis

Ahammout

Perez

Birgfeld

et al. 2021

Plastic &Amp; Reconstructive Surgery

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Background: Postoperative computed tomography scans allow for evaluation of the structural results of cranial vault reconstruction and potential surgical concerns. The authors evaluated the clinical utility of routine postoperative scans to identify relevant surgical findings in children treated for craniosynostosis. Methods: The authors conducted a retrospective study of postoperative computed tomography reports for patients with craniosynostosis following cranial vault reconstruction during a 9-year period at their tertiary care pediatric hospital. They categorized postoperative computed tomography findings as typical, atypical, or indeterminate. Images with reported indeterminate or atypical findings were reviewed and verified by a pediatric neuroradiologist and a pediatric neurological surgeon. Clinical outcomes of patients with abnormal postoperative images were assessed with chart review for clinical relevance. Results: Postoperative computed tomography radiology reports for 548 operations in 506 participants were included. Most participants had single-suture craniosynostosis (89 percent), were male (64 percent), and under 1 year of age (78 percent). Surgically concerning scans were described in 52 reports (<9.5 percent), and the research team's pediatric neuroradiologist confirmed abnormal findings in 36 (6.5 percent). Potentially relevant abnormal findings included subdural blood (n = 18), subarachnoid blood (n = 4), intraparenchymal findings (n = 6), bone abnormalities (n = 5), vascular injury (n = 3), and increased ventricular size (n = 2). Most cases with abnormal findings did not require additional observation nor intervention. Only three cases (of 548; 0.55 percent) required further intervention, which included additional medical management (n = 2) and return to the operating room (n = 1). Conclusion: Abnormal findings on routine computed tomography scans after cranial vault reconstruction are uncommon and rarely result in an urgent surgical or medical intervention.

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Section: Discussionmentioning

confidence: 99%

Evaluating the Utility of Routine Computed Tomography Scans after Cranial Vault Reconstruction for Children with Craniosynostosis

Ahammout

Perez

Birgfeld

et al. 2021

Plastic &Amp; Reconstructive Surgery

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“…Postoperative complications include hemorrhage, osteomyelitis, meningitis, hydrocephalus, epilepsy, cerebrospinal fluid (CSF) leak, electrolyte imbalance, fever, and accidental trauma to the relatively unprotected brain. 5,9 Subdural hygroma developing as a complication after craniosynostosis correction surgery is a rare but possible complication.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative hemorrhage from the venous sinuses and the danger of air embolism or venous infarct represent a major risk in craniosynostosis surgery. 5 Postoperative complications include hemorrhage, osteomyelitis, meningitis, hydrocephalus, epilepsy, and accidental trauma to the relatively unprotected brain. 1 We report a case of subdural hygroma (SDHy) that developed in an infant after cranial vault reconstruction surgery for the correction of craniosynostosis.…”

mentioning

confidence: 99%

Subdural Hygroma After Craniosynostosis Remodeling Surgery

Ganesh

Nagarjuna

Shetty

et al. 2015

Journal of Craniofacial Surgery

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Craniosynostosis is defined as the premature fusion of the cranial sutures and can cause functional impairment or cosmetic deformity. Surgical techniques for the correction of craniosynostosis have changed overtime, as so have the intraoperative and postoperative complications. Extensive surgeries involving fronto-orbital unit repositioning and cranial vault remodeling are associated with various complications. Intraoperative and postoperative hemorrhage, venous infarct, air embolism, hydrocephalus, cerebrospinal fluid leak, as well as meningitis are a few complications associated with cranial vault remodeling surgery. Postoperative complications can increase the morbidity and mortality associated with these procedures. Identification of the complications and their timely management should be a part of every craniofacial reconstruction team's training program.In this article, we report a case of subdural hygroma in an infant after cranial vault remodeling procedure. Subdural hygroma is a known complication following head injuries and represents 5% to 20% of posttraumatic intracranial mass lesions. However, subdural hygroma developing after a cranial procedure is rare and has not been reported in the literature. Identification of the complication, close monitoring of the change in subdural fluid volume, and tapping of the fluid through the craniotomy site if indicated form the mainstay of management of subdural hygroma that develops after cranial vault remodeling surgery.

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“…16 However, there is also morbidity associated with transfusions, such as metabolic acidosis and transfusion reactions. [17][18][19][20][21][22] Multiple strategies and approaches have been described to reduce the volume of blood loss and the requirement for blood transfusion and include preoperative optimization, surgical approaches modified to reduce blood loss, and perioperative algorithms.…”

Section: Introductionmentioning

confidence: 99%

Optimizing Blood Loss and Management in Craniosynostosis Surgery: A Systematic Review of Outcomes Over the Last 40 Years

Coombs

Knackstedt

Patel

2022

The Cleft Palate Craniofacial Journal

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Surgical correction of craniosynostosis can involve significant blood loss. Rates of allogenic blood transfusion have been reported to approach 100%. Multiple interventions have been described to reduce blood loss and transfusion requirements. The aim of this study was to analyze various approaches over the last 4 decades to optimize blood loss and management during craniosynostosis surgery. PRISMA guidelines for systematic reviews were followed. PubMed and Cochrane database searches identified studies analyzing approaches to minimizing blood loss or transfusion rate in craniosynostosis surgery. Primary outcomes included rate or amount of allogenic or autologous blood transfusion, estimated blood loss (EBL), postoperative hemoglobin (Hg), or hematocrit (Hct) levels. Secondary outcomes were examined when reported. Fifty-two studies met inclusion criteria. There was marked heterogeneity regarding design, inclusion criteria, surgical intervention, and endpoints. The majority of the studies were nonrandomized and noncomparative. Four studies analyzed erythropoietin (EPO), 6 analyzed various cell-saver (CS) technologies, 18 analyzed antifibrinolytics (tranexamic acid [TXA], aminocaproic acid [ACA], and aprotinin [APO]), 8 analyzed various alternatives, and 16 analyzed multimodal pathways & protocols. Some studies analyzed multiple approaches. Although the majority of studies reviewed represent level III/IV evidence, several high-quality level I studies were identified and included. Level I evidence supported an improvement in blood outcomes by utilizing EPO, CS, and TXA, individually or in concert with one another. Thus, this review suggests that a multi-prong approach may be the most effective means to optimize blood loss and transfusion outcomes in craniosynostosis surgery.

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Venous Air Embolism During a Craniofacial Procedure

Cited by 48 publications

References 0 publications

Evaluating the Utility of Routine Computed Tomography Scans after Cranial Vault Reconstruction for Children with Craniosynostosis

Evaluating the Utility of Routine Computed Tomography Scans after Cranial Vault Reconstruction for Children with Craniosynostosis

Subdural Hygroma After Craniosynostosis Remodeling Surgery

Optimizing Blood Loss and Management in Craniosynostosis Surgery: A Systematic Review of Outcomes Over the Last 40 Years

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