Optimizing Reconstruction in Craniosynostosis: A 10-Year Review of 141 Non-Syndromic Patients Treated With a Novel Technique
Hayeem L. Rudy, BA1, Sean B. Herman, M.D.2, David Staffenberg, MD3, James T. Goodrich, M.D., PhD.3, Oren M. Tepper, M.D.2.
1Albert Einstein College of Medicine, Bronx, NY, USA, 2Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, 3Department of Plastic Surgery, Hansjorg Wyss, New York University, New York, NY, USA, 4Division of Pediatric Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
PURPOSE: Open cranial vault remodeling (CVR) with autologous split calvarial bone grafts redistributes and recontours calvarium to create an expanded cranial vault in patients with craniosynostosis. We report a 10-year retrospective review of 141 non-syndromic patients who underwent operative repair using this well-described technique which portends excellent surgical outcomes, maximizes operative efficiency, and decreases total blood loss with low revision and complication rates.
METHODS: The surgical and anesthesia records for each patient were analyzed and data was gathered on operative time, estimated blood loss, and intraoperative transfusion volumes. Intraoperative and post-operative complications, the need for revision surgery, post-operative length of stay, and follow-up records were also reviewed. Patients who underwent either anterior or posterior vault remodeling were compared.
RESULTS: Calvarial bone was successfully split in 100% of cases. Patients undergoing anterior CVR were significantly older than those undergoing posterior CVR (p<0.003). They also had significantly greater estimated blood loss (p<0.003) and longer operative time than posterior CVR patients (p<.0001). There were no significant differences between groups with regards to revision rate and complications. CONCLUSION: This approach has not only led to excellent surgical outcomes with a low recurrence rate, but also maximizes operative efficiency, and decreases total blood loss and transfusion volume. This technique can be applied to any affected suture and therefore any abnormally shaped skull, even if the patient is undergoing secondary repair.
|Anterior CVR||Posterior CVR||P value|
|Operative Time (minutes)||282.18(260-361)||214.76(181-261)||<0.0001|
|Estimated Blood Loss (cc)||199.83(100-250)||140.0 (50-200)||<0.003|
|Blood Transfusion Volume (cc)||177.07(120-250)||151.25(90-195)||0.2349|
|Length of Stay (days)||5.66(4.0-6.0)||5.01(4.0-5.0)||0.1523|
|Follow-up (months)||39.66 (13.0-54.0)||46.72(16.0-73.0)||0.244|
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