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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Evaluation of the safety of posterior cranial vault reconstruction
Elliott H Chen1, Mirko S Gilardino, Linton A Whitaker
1Cleveland, Ohio; and Philadelphia, Pa. From Case Western Reserve, Children's Hospital of Philadelphia, and the University of Pennsylvania.
Insights
Posterior vault reconstruction has a 28% complication rate, with syndromic patients experiencing more intraoperative issues and blood loss. This study highlights risks associated with the procedure.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Posterior vault reconstruction is a common procedure for occipital cranium repair.
- Safety and complication data for posterior vault reconstruction are not well-documented.
Purpose of the Study:
- To evaluate the safety and complication rates of posterior vault reconstruction.
- To compare outcomes between syndromic and nonsyndromic patients.
Main Methods:
- Retrospective chart review of 50 posterior vault reconstruction cases (1996-2006).
- Data collected included diagnoses, operative details, complications, blood loss, and length of stay.
Main Results:
- Overall complication rate was 28% (14% intraoperative, 14% postoperative).
- Syndromic patients had significantly higher blood loss (60.6% vs. 50.0%) and intraoperative complications.
- Length of surgery was also significantly longer in syndromic patients.
Conclusions:
- Posterior vault reconstruction carries a notable risk of intraoperative complications and blood loss.
- Syndromic patients face increased risks during this procedure compared to nonsyndromic patients.
Background:
Posterior vault reconstruction involves exposure, craniotomy, and reconstruction of the occipital cranium. Although it is commonly performed, the safety and complications associated with posterior vault reconstruction have not been specifically or thoroughly examined.
Methods:
A retrospective chart review was performed for all patients undergoing posterior vault reconstruction at the Children's Hospital of Philadelphia between 1996 and 2006. Diagnosis, operative indication, age and weight at time of surgery, procedure type, intraoperative and postoperative complications, estimated blood loss, blood transfusion volume, and length of surgery and admission were recorded.
Results:
Fifty posterior vault reconstruction cases were included in the study (17 syndromic and 33 nonsyndromic). Mean estimated blood loss was 53.6 percent (range, 15.9 to 142.9 percent) of total blood volume and was statistically greater in syndromic patients (60.6 percent versus 50.0 percent; p = 0.038). Transfusion volume averaged 66.1 percent of total blood volume but was not statistically significant. Length of surgery and number of intraoperative complications were significantly elevated in the syndromic cohort (p = 0.007 and p = 0.037, respectively), whereas length of admission and number of postoperative complications were not. Complications were intraoperative in seven patients (14 percent) and postoperative in seven (14 percent), for an overall complication rate of 28 percent.
Conclusions:
This is the largest series to date addressing the safety and complications of posterior vault reconstruction. In the authors' experience, posterior vault reconstruction carries a higher risk of intraoperative complications and blood loss compared with that reported in the literature for other types of cranial vault reconstruction. In addition, syndromic patients were more likely than nonsyndromic patients to encounter intraoperative problems.
