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Safety of Open Cranial Vault Surgery for Single-Suture Craniosynostosis: A Case for the Multidisciplinary Team
Craig B Birgfeld1, Lynette Dufton, Heather Naumann
1Seattle Children's Hospital, Seattle, WA.
Insights
Surgical treatment for single suture craniosynostosis (SSC) has become safer due to advancements in surgical techniques and multidisciplinary care. This evolution has resulted in an acceptable safety profile for cranial vault surgery in SSC patients.
Area of Science:
- Craniofacial surgery
- Pediatric neurosurgery
- Surgical outcomes
Background:
- Single Suture Craniosynostosis (SSC) affects 1 in 2,500 live births, representing the most common craniosynostosis type.
- Surgical approaches for SSC have evolved over the past century, with open techniques now tailored to specific suture types.
- Multidisciplinary team care is increasingly standard for SSC management, enhancing patient outcomes.
Purpose of the Study:
- To evaluate the safety and outcomes of cranial vault surgery for Single Suture Craniosynostosis (SSC).
- To analyze the impact of evolving surgical techniques and multidisciplinary care on SSC treatment.
Main Methods:
- Retrospective review of 88 patients with SSC who underwent cranial vault surgery between 2002 and 2006.
- Analysis of pre-operative assessments, surgical techniques, anesthetic events, and intra-operative/post-operative adverse events.
- Data collected from the Infant Learning Project at Seattle Children's Hospital.
Main Results:
- No deaths or major intraoperative complications were reported in 88 patients.
- Minor events included hypothermia (9), coagulopathy (2), and low hematocrit (55); 99% received transfusions.
- Average hospital stay was 3.4 days, with no major post-operative complications and no return to the operating room within 6 months.
Conclusions:
- Open cranial vault surgery for SSC has evolved into a safer procedure with an acceptable safety profile.
- The integration of multidisciplinary team care and streamlined protocols has improved SSC management.
- Modern SSC treatment combines refined surgical procedures with comprehensive pre- and post-operative care.
Introduction:
Single Suture Craniosynostosis (SSC) occurs in 1 in 2,500 live births and is the most common type of craniosynostosis treated in most centers. Surgical treatment has evolved over the past century and open techniques are tailored to the specific suture type. Additionally, the concept of multi-disciplinary team care has proliferated and is becoming the standard of care for SSC. The combination of these evolutions, we believe, has improved the safety of cranial vault surgery for SSC.
Methods:
A retrospective review of patients participating in the Infant Learning Project at Seattle Children's Hospital who underwent cranial vault surgery for treatment of SSC between 2002 and 2006 was performed. Pre-operative assessment, surgical techniques, anesthetic and intraoperative events and both intra-operative and post-operative adverse events were analyzed.
Results:
Eighty eight patients fulfilled the inclusion criteria (42 sagittal, 23 metopic, 19 unicoronal, 4 lambdoid). Length of procedure varied (FOA 5.2 hrs, modified pi 2.5 hrs, total vault 4.9 hrs and switch cranioplasty 4.6 hrs), as did transfusion amount (FOA 385 mL, modified pi 216 mL, total vault 600 mL, switch cranioplasty 207 mL) although 99% of patients received a transfusion of some sort. There were no deaths and no major intraoperative complications. Minor events include; ET tube malposition (1), desaturation (1), acidosis (1), hypothermia (9), coagulopathy (2), Hct < 25 (55). Average hospital stay was 3.4 days with no major post-operative complications. One patient was readmitted to the ICU and 1 had a scalp hematoma, but no patients returned to the operating room within 6 months after surgery.
Discussion:
The surgical treatment of SSC has evolved from lengthy, risky procedures to become almost routine at most craniofacial centers. Additionally, the care for patients with SSC has evolved from a single provider to a multidisciplinary team concept based around protocols for workup, delivery of anesthesia, streamlined surgical procedures and post-operative care and assessment. This evolution has given open cranial vault surgery for SSC an acceptable safety profile.
