Related Experiment Video
Updated: Apr 8, 2026
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
The value of tranexamic acid during fronto-orbital advancement in isolated metopic craniosynostosis
Michael Engel1, Jens P Bodem1, Cornelius J Busch2
1Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Jürgen Hoffmann, MD, DDS), University Hospital Heidelberg, Germany.
Insights
Tranexamic acid (TXA) significantly reduces blood loss and red blood cell (RBC) transfusion in pediatric craniofacial surgery. This antifibrinolytic agent is recommended for routine use in front-orbital advancement procedures.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Hematology
Background:
- Craniofacial surgery in infants carries risks of substantial blood loss and red blood cell (RBC) transfusion.
- Fronto-orbital advancement (FOA) for metopic synostosis can involve significant intraoperative bleeding.
Purpose of the Study:
- To evaluate the antifibrinolytic effect of tranexamic acid (TXA) on intraoperative blood loss.
- To assess the impact of TXA on RBC transfusion rates during FOA in pediatric patients.
Main Methods:
- A comparative study of 33 children undergoing FOA for metopic synostosis.
- Patients were divided into two groups: intraoperative TXA (TXA group, n=17) and no TXA (non-TXA group, n=16).
- Calculated blood loss (CBL) and RBC transfusion volumes were analyzed, adjusted for weight.
Main Results:
- The TXA group showed significantly lower mean CBL (158.8 ml vs. 198.5 ml) and weight-adjusted CBL (19.1 ml/kg vs. 22.3 ml/kg).
- Mean RBC transfusion volumes were also significantly lower in the TXA group (252.2 ml vs. 280.0 ml) and weight-adjusted (27.9 ml/kg vs. 31.3 ml/kg).
- Surgical duration did not differ between groups, indicating TXA's effect was independent of procedure length.
Conclusions:
- Intraoperative TXA effectively minimizes blood loss and the need for RBC transfusions in pediatric FOA.
- Antifibrinolytic agents like TXA should be considered for routine use in pediatric craniofacial surgery to improve patient outcomes.
Abstract:
Craniofacial surgery in infants still harbors the risk of significant blood loss and the need for red blood cell (RBC) transfusion. Hence, the aim of the present study was to investigate the antifibrinolytic effect of tranexamic acid (TXA) on intraoperative blood loss and RBC transfusion rates during fronto-orbital advancement (FOA) in isolated metopic synostosis. A total of 33 children with metopic synostosis were operated on using standardized FOA, of which 16 patients (48.5%) were treated without intraoperative TXA (non-TXA group) and 17 patients (51.5%) received TXA intraoperatively (TXA group). To accurately evaluate the calculated blood loss (CBL) we analyzed the values for pre- and postoperative hematocrit and the volume of the RBC transfusion. The mean CBL and the mean weight-adjusted CBL was significantly lower for patients receiving TXA compared with the non-TXA group (158.8 ml vs. 198.5 ml, p = 0.0001; and 19.1 ml/kg vs. 22.3 ml/kg, p = 0.0293, respectively). In addition, the mean RBC transfusion and the mean weight-adjusted RBC transfusion was significantly lower for the TXA group (252.2 ml vs. 280.0 ml, p = 0.0001; and 27.9 ml/kg vs. 31.3 ml/kg, p = 0.0345, respectively). The mean duration of the surgical procedure did not differ statistically between the groups (132 min vs. 136 min, p = 0.4081), hence the lower CBL in the TXA-group was not related to a shorter cutting-suture time. As the use of intraoperative TXA minimizes blood transfusion volumes in children who undergo FOA, antifibrinolytics, such as TXA, should be considered for routine use in pediatric craniofacial surgery.
