Benefit of Piezoosteotomy in Cranioplasties for Craniosynostosis Correction versus Conventional Saw-and-Chisel Osteotomy: A Pilot Study. (May 2015) - Landes, Constantin
Objective: Pilot study evaluation of the benefit of piezoosteotomy in cranioplasty of craniosynostoses, based on clinical data. Design: Retrospective case-control study. Setting: Universitarian institution. Patients: Craniosynostosis patients (n = 19) operated upon conventionally with a craniotome and microsaw versus 19 patients operated upon with a piezoosteotomy and a craniotome. Intervention: Piezoosteotomy of the supraorbital "bandeau" and osteotomies on part of the parietal and occipital regions versus conventional saw-and-chisel osteotomy. Main Outcome Measures: Perioperative age, weight, laboratory parameters, transfusion and infusion requirements, operation time, and blood loss. Results: The intraoperative erythrocyte concentrate transfusion and noncolloidal infusions were comparable ( P = .15; P = .56). The fresh frozen plasma transfusion was significantly higher ( P = .03); possibly, the anesthesiologist's reaction was secondary to the higher irrigation-fluid accumulation in the aspiration bag during piezoosteotomy. The postoperative erythrocyte concentrate transfusion rate was significantly lower ( P = .01) as a result of local hemostasis in piezoosteotomy. The fresh frozen plasma transfusion and noncolloidal infusion volumes were nonsignificantly lower ( P = .27; P = .85). Operation time was slightly shorter with a smaller standard deviation ( P = .09), due to a lower rate of dural lacerations and consecutive repair; patients in the study group were on the intensive care unit half a day less ( P = .73) than those in the control group. C-reactive protein was significantly lower preoperatively ( P = .00) and on the operation day ( P = .01) and nonsignificant postoperatively ( P = .81); hematocrit was postoperatively higher ( P = .23). Thrombocytes were preoperatively lower and postoperatively higher, both nonsignificant ( P = .29; P = .52). Conclusions: Piezoosteotomy appears to be less traumatic than conventional saw-and-chisel osteotomy by the evaluated parameters. The main study limitation is its nonrandomized retrospective design; results should be confirmed by a randomized controlled trial.