Perioperative outcomes in the treatment of isolated sagittal synostosis: Cranial vault remodeling versus spring mediated cranioplasty

Viren Patel, Sameer Shakir, Robin Yang, Laura S. Humphries, Rachel A. McKenna, Gregory Heuer, Shih Shan Lang, Scott P. Bartlett, Jesse A. Taylor, Jordan W. Swanson

Research output: Contribution to journalArticlepeer-review

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 ¼ 6 (9.2%) and n ¼ 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 ¼ 2 (3.1%) and n ¼ 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.

Original languageEnglish (US)
Pages (from-to)2106-2111
Number of pages6
JournalJournal of Craniofacial Surgery
Volume31
Issue number7
DOIs
StatePublished - Oct 2020
Externally publishedYes

Keywords

  • Anemia
  • Cranioplasty
  • Craniosynostosis
  • ICU
  • Intensive care
  • Pediatric
  • Perioperative
  • Sagittal
  • Springs
  • Synostosis
  • Utilization
  • Value
  • Vault remodeling

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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