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Perioperative morbidity in posterior cranial vault expansion: distraction osteogenesis versus conventional osteotomy
Jesse A Taylor1, Christopher A Derderian, Scott P Bartlett
1Philadelphia, Pa. From the Departments of Surgery and Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine.
Background:
The treatment of multisuture syndromic craniosynostosis is in evolution, with an increasing prevalence of reports on posterior vault expansion with distraction osteogenesis over conventional osteotomy. The purported benefits of distraction osteogenesis include less perioperative morbidity. The authors conducted this preliminary study to compare the perioperative course in children undergoing posterior cranial vault expansion with distraction osteogenesis versus conventional osteotomy.
Methods:
A query was performed of the authors' institutional review board-approved, prospective, craniofacial registry for posterior cranial expansion between 2008 and 2011. Data collected included age, weight, diagnosis, surgical procedure and duration, perioperative laboratory data, number of perioperative blood donor exposures, length of intensive care unit and hospital stay, and intraoperative and postoperative complications. Data for conventional osteotomy and distraction osteogenesis were then compared.
Results:
The registry query returned data from 25 subjects (16 with conventional osteotomy and nine with distraction osteogenesis). There were no significant differences in age or weight between the two groups. Mean total surgery time for conventional osteotomy was 239 ± 48 minutes versus 200 ± 70 minutes for distraction osteogenesis (p = 0.11). Intensive care unit stay was a median of 3.5 days with conventional osteotomy versus 4.0 days for distraction osteogenesis (p = 0.10). There was no statistically significant difference in median hospital length of stay, calculated blood loss in blood volumes, total perioperative blood donor exposures, intraoperative complications, or postoperative complications.
Conclusions:
The results from this review of the authors' early experience with posterior vault distraction osteogenesis suggest that distraction osteogenesis and conventional osteotomy have similar perioperative safety and morbidity profiles. These data may seem counterintuitive, and the perioperative course of children undergoing distraction osteogenesis is likely to improve as experience with distraction osteogenesis increases.
Clinical Question/Level Of Evidence:
Therapeutic, II.
