An Evaluation of Complications, Revisions, and Long-Term Aesthetic Outcomes in Nonsyndromic Metopic Craniosynostosis

Wes, Ari M.; Paliga, J. Thomas; Goldstein, Jesse A.; Whitáker, Linton A.; Bartlett, Scott P.; Taylor, Jesse A.

doi:10.1097/prs.0000000000000223

Cited by 91 publications

(102 citation statements)

References 24 publications

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“…The majority of studies focus on aesthetic markers, pre-and postoperatively. 1,9,11,13,18 Although cosmetic parameters are a critical part of the clinical evaluation in trigonocephaly, the use of aesthetic markers in combination with objective measures may allow for more optimal preoperative evaluation, operative planning, and postoperative assessment of correction and need for further therapy. Many studies have described nor- mative anthropometric cranial measurements and proportion indices in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

The metopic index: an anthropometric index for the quantitative assessment of trigonocephaly from metopic synostosis

Wang¹,

Dorafshar

Liu³

et al. 2016

PED

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OBJECTIVE Because the metopic suture normally fuses during infancy, there are varying degrees of severity in head shape abnormalities associated with premature fusion. A method for the objective and reproducible assessment of metopic synostosis is needed to guide management, as current methods are limited by their reliance on aesthetic markers. The object of this study was to describe the metopic index (MI), a simple anthropometric cranial measurement. The measurements can be obtained from CT scans and, more importantly, from palpable cranial landmarks, and the index provides a rapid tool for evaluating patients in both pre- and postoperative settings. METHODS High-resolution head CT scans obtained in 69 patients (age range 0–24 months) diagnosed with metopic craniosynostosis were retrospectively reviewed. Preoperative 3D reconstructions were available in 15 cases, and these were compared with 3D reconstructions of 324 CT scans obtained in a control group of 316 infants (age range 0–24 months) who did not have any condition that might affect head size or shape and also in a subset of this group, comprising 112 patients precisely matched to the craniosynostosis patients with respect to age and sex. Postoperative scans were available and reviewed in 9 of the craniosynostosis patients at a mean time of 7.1 months after surgical repair. 3D reconstructions of these scans were matched with controls based upon age and sex. RESULTS The mean preoperative MI for patients with trigonocephaly was 0.48 (SD 0.05), significantly lower than the mean values of 0.57 (SD 0.04) calculated on the basis of all 324 scans obtained in controls (p < 0.001) and 0.58 (SD 0.04) for the subset of 112 age- and sex-matched controls (p < 0.001). For 7 patients with both pre- and postoperative CT scans available for evaluation, the mean postoperative MI was 0.55 (SD 0.03), significantly greater than their preoperative MIs (mean 0.48 [SD 0.04], p = 0.001) and comparable to the mean MI of the controls (p = 0.30). In 4 patients, clinically obtained postoperative MIs by caliper measurement were comparable to measurements derived from CT (p = 0.141). CONCLUSIONS The MI is a useful measurement of the severity of trigonocephaly in patients with metopic synostosis. This simple quantitative assessment can potentially be used in the clinical setting to guide preoperative evaluation, surgical repair, and postoperative degree of correction.

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Section: Discussionmentioning

confidence: 99%

The metopic index: an anthropometric index for the quantitative assessment of trigonocephaly from metopic synostosis

Wang¹,

Dorafshar

Liu³

et al. 2016

PED

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“…[7][8][9][10]14,17,19,21,24 Traditionally, single-institution reports have limited generalizability. Additionally, clinical series that incorporate decades of data may span significant advancements in surgical techniques, technological development, and paradigm shifts in medical and surgical management.…”

Section: The Reported Complication Rates After Craniosynostosis Surgementioning

confidence: 99%

“…10,21,24 Variations in blood transfusion in the perioperative period after craniosynostosis surgery may reflect differences in surgical technique, institutional thresholds for transfusion, and type of synostosis requiring treatment. The transfusion rates that were reported in KID (36%) were very different from those in Peds NSQIP (64%).…”

Section: The Rates Of Blood Transfusion Differed Between Kid and Pedsmentioning

confidence: 99%

“…Published accounts often examine heterogeneous cohorts of patients across multiple years or epochs. 10,17,19,24 An advantage of research that uses large, national databases, such as KID or Peds NSQIP, is the ability to analyze homogeneous definitions of relatively sizeable patient cohorts in a narrow time window, as surgical techniques evolve quickly. To date, no study has analyzed the rates of complications after craniosynostosis surgery in this manner.…”

mentioning

confidence: 99%

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Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

Lin

Pan

Mayer

et al. 2015

FOC

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OBJECT Research conducted using large administrative data sets has increased in recent decades, but reports on the fidelity and reliability of such data have been mixed. The goal of this project was to compare data from a large, administrative claims data set with a quality improvement registry in order to ascertain similarities and differences in content. METHODS Data on children younger than 12 months with nonsyndromic craniosynostosis who underwent surgery in 2012 were queried in both the Kids’ Inpatient Database (KID) and the American College of Surgeons Pediatric National Surgical Quality Improvement Program (Peds NSQIP). Data from published clinical craniosynostosis surgery series are reported for comparison. RESULTS Among patients younger than 12 months of age, a total of 1765 admissions were identified in KID and 391 in Peds NSQIP in 2012. Only nonsyndromic patients were included. The mean length of stay was 3.2 days in KID and 4 days in Peds NSQIP. The rates of cardiac events (0.5% in KID, 0.3% in Peds NSQIP, and 0.4%-2.2% in the literature), stroke/intracranial bleeds (0.4% in KID, 0.5% in Peds NSQIP, and 0.3%-1.2% in the literature), infection (0.2% in KID, 0.8% in Peds NSQIP, and 0%-8% in the literature), wound disruption (0.2% in KID, 0.5% in Peds NSQIP, 0%-4% in the literature), and seizures (0.7% in KID, 0.8% in Peds NSQIP, 0%-0.8% in the literature) were low and similar between the 2 data sets. The reported rates of blood transfusion (36% in KID, 64% in Peds NSQIP, and 1.7%-100% in the literature) varied between the 2 data sets. CONCLUSIONS Both the KID and Peds NSQIP databases provide large samples of surgical patients, with more cases reported in KID. The rates of complications studied were similar between the 2 data sets, with the exception of blood transfusion events where the retrospective chart review process of Peds NSQIP captured almost double the rate reported in KID.

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“…Although in recent studies, generally male-to-female ratios were equal or females had numerical superiority (1,5,10,19,24), the obvious majority of boys in our study may be due to the sociodemographic characteristics of the cases.…”

Section: █ Discussionmentioning

confidence: 40%

The management of blood loss in non-syndromic craniosynostosis patients undergoing barrel stave osteotomy

Küçük

Tümtürk²,

Gergin³

et al. 2015

Turkish Neurosurgery

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ABSTRACTare used in an attempt to keep the body temperature stable and it may be monitored continuously by a probe. However, it is nearly impossible to objectively evaluate the amount of bleeding in the calvarium while undergoing a barrel stave osteotomy. Therefore, the intraoperative observations of the surgeon, his experience, and his communication with the anesthetist and monitoring of vital signs are important in determining perioperative blood and fluid losses (13).Our aim was to evaluate blood loss and administration of blood products in patients being operated on to treat craniosynostosis, while taking age, body weight, type of craniosynostosis, preoperative and postoperative hemoglobin and hematocrit levels in to consideration. █ INTRODUCTION C raniosynostosis is the early and pathologic closure of one or more sutures in the cranium, generally causing an abnormal appearance (21). Although craniosynostosis cases are referred to a physician for cosmetic reasons, the main aim of neurosurgeons in treating craniosynostosis is to relieve an increase in potential intracranial pressure on the neural tissues and prevent and or treat disorders of cognitive function. Thus, a widely used procedure in neurosurgery, barrel stave osteotomy, is applied to the majority of craniosynostosis cases. Hypothermia and hypovolemia are the most important causes of morbidity and mortality in surgical interventions of craniosynostosis (18). During surgery, heating blankets AIm: Barrel stave osteotomy is a widely used procedure in neurosurgery for the majority of craniosynostosis patients. Both in the intraoperative and postoperative periods, there is inevitable leakage type bleeding from the bones undergoing osteotomy. A number of studies have been performed in order to prevent this complication but a concise procedure is still lacking. mATERIAl and mEThODS: Synostectomy and parietotemporal barrel stave osteotomy were applied to 143 patients who were operated on with a diagnosis of craniosynostosis between the years 2005-2013. At the beginning to osteotomy, 5 ml/kg erythrocyte suspension (ES) was given for probable blood loss. Whole blood count was performed at the postoperative 1 st and 6 th hours and cases with hemoglobin levels below 10 or with hematocrit levels which had decreased more than 5% between the 1 st and 6 th hours were administered erythrocyte transfusion. RESUlTS:Of the patients, 100 were boys and 43 were girls. Of these, 98 had metopic, 30 had sagittal, 9 had metopic+sagittal, 4 had unilateral, 2 had bilateral and 6 had coronal synostosis. All the cases were administered intraoperative erythrocyte suspension. The preoperative amount of administered mean erythrocyte was 8.61 ml/kg. In the postoperative period, 92 patients were administered erythrocyte suspension. The postoperative amount of administered mean erythrocyte suspension was 7.98 ml/kg. CONClUSION:For an operated infant with craniosynostosis who is operated on in the first year of life, undergoing osteotomy and inevitable bone-borne blood losses are very i...

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An Evaluation of Complications, Revisions, and Long-Term Aesthetic Outcomes in Nonsyndromic Metopic Craniosynostosis

Abstract: Therapeutic, IV.

Cited by 91 publications

References 24 publications

The metopic index: an anthropometric index for the quantitative assessment of trigonocephaly from metopic synostosis

The metopic index: an anthropometric index for the quantitative assessment of trigonocephaly from metopic synostosis

Complications after craniosynostosis surgery: comparison of the 2012 Kids’ Inpatient Database and Pediatric NSQIP Database

The management of blood loss in non-syndromic craniosynostosis patients undergoing barrel stave osteotomy

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