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Published on: August 11, 2015
Paediatric transcranial surgery: a review of 114 consecutive procedures
W N A Kirkpatrick1, C E Koshy, N Waterhouse
1Department of Craniofacial Surgery, Chelsea and Westminster Hospital, London, UK.
Insights
Paediatric transcranial procedures in children are safe when performed by experienced multidisciplinary teams. This review of 114 procedures found a low complication rate, highlighting the importance of careful planning and surgical principles.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Surgical Outcomes
Background:
- Craniofacial units are responsible for data collection, research, training, and audit.
- Paediatric transcranial procedures are complex interventions requiring careful management.
Purpose of the Study:
- To review complications associated with paediatric transcranial procedures.
- To identify factors contributing to a low complication rate in a dedicated craniofacial unit.
Main Methods:
- Retrospective review of 114 consecutive transcranial procedures in 110 children over an 8-year period.
- Analysis of operative data, focusing on complications, including blood loss, infections, and minor issues.
Main Results:
- No deaths occurred in the series.
- Complications included two cases of excessive intraoperative blood loss and two postoperative infections.
- Thirteen patients experienced minor complications delaying hospital discharge.
Conclusions:
- Paediatric transcranial procedures can be performed safely in specialized centers with experienced multidisciplinary teams.
- Multidisciplinary assessment, planning, adherence to surgical principles, shorter operating times, and avoidance of high-risk procedures contribute to low complication rates.
- Complex osteotomies in syndromic conditions carry a higher complication risk than single sutural synostosis correction.
Abstract:
Craniofacial units have a responsibility to collect data, to promote research and training and to carry out audit. We present a review of 114 consecutive transcranial procedures performed in 110 children in our unit over an 8 year period, with particular reference to complications. There were no deaths in this series. Complications included two cases of excessive intraoperative blood loss necessitating a delay in the procedure, and two postoperative infections that required aggressive antibiotic management. Minor complications, delaying hospital discharge, occurred in 13 patients. Within the range of paediatric transcranial procedures performed, the potential for complications is greater for complex osteotomies in syndromic conditions than for single sutural synostosis correction. The transcranial case mix included a relatively small number of craniofacial dysostoses, which contributes to the very low complication rate reported. This report demonstrates that multidisciplinary assessment and planning, adherence to craniofacial surgical principles, shorter operating times and avoidance of high-risk procedures contribute to a low complication rate, and confirms that paediatric transcranial procedures can be safely performed in dedicated centres where there is a multidisciplinary team with appropriate commitment and experience.
