Perioperative Outcomes in the Treatment of Isolated Sagittal Synostosis: Cranial Vault Remodeling Versus Spring Mediated Cranioplasty. Issue 7 (October 2020)

• Record Type: Journal Article
• Authors: Patel, Viren; Shakir, Sameer; Yang, Robin; Humphries, Laura S.; McKenna, Rachel A.; Heuer, Gregory; Lang, Shih-Shan; Bartlett, Scott P.; Taylor, Jesse A.; Swanson, Jordan W.
• Is Part Of: Journal of craniofacial surgery. Volume 31:Issue 7(2020)
• Publication Date: 2020-10
• Subjects: Anemia -- cranioplasty -- craniosynostosis -- ICU -- intensive care -- pediatric -- perioperative -- sagittal -- springs -- synostosis -- utilization -- value -- vault remodeling; Facial bones -- Surgery -- Periodicals; Skull -- Surgery -- Periodicals; Face -- Surgery -- Periodicals; Surgery, Plastic -- Periodicals; 617.52
• DOI: 10.1097/SCS.0000000000006838
• Languages: English
• ISSNs: 1049-2275

Abstract

Abstract : Background: Patients undergoing cranial expansion including spring-mediated cranioplasty (SMC) and cranial vault remodeling (CVR) receive costly and high acuity post-operative intensive care (ICU) given concerns over neurologic and hemodynamic vulnerability. The authors analyzed perioperative and post-operative events for patients presenting with sagittal craniosynostosis (CS) undergoing SMC and CVR in order to compare complication profiles. Methods: The authors performed a single center retrospective cohort study of patients undergoing SMC and CVR for the treatment of nonsyndromic, isolated sagittal CS from 2011 to 2018. Perioperative and post-operative factors were collected, focusing on hemodynamic instability and events necessitating ICU care. Mann-Whitney U and Fisher exact tests were used to compare data with significance defined as P < 0.05. Results: Among 106 patients, 65 (61%) underwent SMC and 41 (39%) CVR. All CVR patients received prophylactic whole blood transfusion at time of scalp incision. Acute blood loss anemia was the most common post-operative complication, prompting n = 6 (9.2%) and n = 7 (17.1%) blood transfusions in the SMC and CVR cohorts, respectively ( P < 0.24). Hemodynamic instability requiring blood transfusion was rare, occurring post-operatively in n = 2 (3.1%) and n = 2 (4.9%) patients in the SMC and CVR cohorts, respectively ( P < 0.64). Two patients in the CVR cohort exhibited new neurologic symptoms that self-resolved, compared to no patients in the SMC cohort ( P < 0.15). Conclusion: Despite differing degrees of operative invasiveness, post-operative hemodynamic and neurologic decompensation following CVR and SMC for isolated sagittal CS repair remains similarly rare. Indications necessitating post-operative intensive care are infrequent. Post-operative hemoglobin monitoring may enable early prediction for hemodynamic instability. Abstract : Supplemental Digital Content is available in the text