Endoscopically assisted craniosynostosis surgery (EACS): The craniofacial team Nijmegen experience

Delye, Hans; Arts, Sebastian; Borstlap, W.A.; Blok, Laura; Driessen, J. J.; Meulstee, Jene W.; Maal, T.J.J.; Lindert, Erik J. van

doi:10.1016/j.jcms.2016.05.014

Cited by 28 publications

(33 citation statements)

References 21 publications

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“…Complications related to helmet therapy, as mentioned in our previously published study, 3 did not occur within 30 days postoperatively. Therefore, these complications did not meet the criteria for POCs in this study.…”

supporting

confidence: 62%

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Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

Arts¹,

Delye²,

Lindert³

2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVETo compare minimally invasive endoscopic and open surgical procedures, to improve informed consent of parents, and to establish a baseline for further targeted improvement of surgical care, this study evaluated the complication rate and blood transfusion rate of craniosynostosis surgery in our department.METHODSA prospective complication registration database that contains a consecutive cohort of all pediatric neurosurgical procedures in the authors’ neurosurgical department was used. All pediatric patients who underwent neurosurgical treatment for craniosynostosis between February 2004 and December 2014 were included. In total, 187 procedures were performed, of which 121 were endoscopically assisted minimally invasive procedures (65%). Ninety-three patients were diagnosed with scaphocephaly, 50 with trigonocephaly, 26 with plagiocephaly, 3 with brachycephaly, 9 with a craniosynostosis syndrome, and 6 patients were suffering from nonsyndromic multisutural craniosynostosis.RESULTSA total of 18 complications occurred in 187 procedures (9.6%, 95% CI 6.2–15), of which 5.3% (n = 10, 95% CI 2.9–10) occurred intraoperatively and 4.2% (n = 8, 95% CI 2.2–8.2) occurred postoperatively. In the open surgical procedure group, 9 complications occurred: 6 intraoperatively and 3 postoperatively. In the endoscopically assisted procedure group, 9 complications occurred: 4 intraoperatively and 5 postoperatively. Blood transfusion was needed in 100% (n = 66) of the open surgical procedures but in only 21% (n = 26, 95% CI 15–30) of the endoscopic procedures. One patient suffered a transfusion reaction, and 6 patients suffered infections, only one of which was a surgical site infection. A dural tear was the most common intraoperative complication that occurred (n = 8), but it never led to postoperative sequelae. Intraoperative bleeding from a sagittal sinus occurred in one patient with only minimal blood loss. There were no deaths, permanent morbidity, or neurological sequelae.CONCLUSIONSComplications during craniosynostosis surgery were relatively few and minor and were without permanent sequelae in open and in minimally invasive procedures. The blood transfusion rate was significantly reduced in endoscopic procedures compared with open procedures.

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confidence: 62%

“…3,[11][12][13] This is probably due to the longer surgical time and the extent of the OCVRS. 28 Although the postoperative hemoglobin level differed significantly between EACS and OCVRS, the difference in postoperative hemoglobin level was biased by the intraoperative transfusions that were administered to patients during OCVRS.…”

mentioning

confidence: 99%

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

Arts¹,

Delye²,

Lindert³

2018

Journal of Neurosurgery: Pediatrics

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“…Mean length of hospital stay was 2.6 days (SD = 1). However, as published in our recent study, there is a learning curve and currently patients stay in our center for only 24 hours postoperatively …”

Section: Discussionmentioning

confidence: 90%

“…This led to the development of minimally invasive techniques such as spring‐assisted craniosynostosis surgery and endoscopic strip craniectomy. These procedures have a lesser impact on the pediatric patient and are related with short surgical duration, short length of hospital stay, less blood loss, low blood transfusion rates, and no need for admission to an intensive care unit after surgery . Several centers show positive results regarding their anesthesia technique during the treatment of craniosynostosis .…”

Section: Introductionmentioning

confidence: 99%

“…We were particularly interested to know the data about blood loss, duration of surgery, anesthesia and hospital stay, and the need for ICU admission. This research is part of a research project regarding minimally invasive techniques in craniosynostosis surgery in which our operative technique and surgical complications have already been published …”

Section: Introductionmentioning

confidence: 99%

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Evaluation of anesthesia in endoscopic strip craniectomy: A review of 121 patients

Arts

Delye

Lindert

et al. 2018

Pediatric Anesthesia

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SummaryObjective: The aim of this study was to evaluate pre-, intra-, and postoperative anesthetic parameters in endoscopic strip craniectomy in order to improve anesthesiological care. Materials and Methods:This is a retrospective patient cohort study of our first 121 patients treated by endoscopic strip craniectomy. Preoperative as well as intra-and postoperative anesthesiological and neurological parameters were analyzed. Furthermore, the need for intensive care unit admission, blood loss, and blood transfusion rate were measured. Results:The mean age of patients was 3.9 months (standard deviation = 1) at a mean weight of 6.3 kg (standard deviation = 1.3). Comorbidity was registered in 13 (11%) patients of which 5 had syndrome-related comorbidities. Mean duration of anesthesia was 131 minutes (standard deviation = 32) . One hundred and sixteen patients were induced by mask induction with sevoflurane and 5 patients were induced intravenously.In 10 patients, mild intraoperative hypothermia (between 35 and 36 degrees Celsius) occurred. The mean estimated blood loss was 35.4 mL (standard deviation = 28.9) and blood transfusion rate was 21.5%. Brief and small intraoperative oxygen saturation drops were common during this study. No indication for venous air embolism was found based on endtidal CO 2 . Postoperative temperature above 38 degrees Celsius occurred 16 times and benign deviations in postoperative cardiopulmonary parameters occurred in 17 patients. Postoperative pain management was mainly established by paracetamol and low-dose morphine when necessary. No postoperative neurological symptoms were reported and no deaths occurred. Conclusion:These patients had a relatively short intraoperative course with stable vital parameters during surgery. We report a low incidence of significant venous air embolism, a blood transfusion rate of 21% and only minor perioperative disturbances in vital parameters.

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RETRACTED CHAPTER: Craniosynostosis: Endoscopically Versus Open Treatment

Delye

2019

Evidence for Neurosurgery

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Endoscopically assisted craniosynostosis surgery (EACS): The craniofacial team Nijmegen experience

Cited by 28 publications

References 21 publications

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

Evaluation of anesthesia in endoscopic strip craniectomy: A review of 121 patients

RETRACTED CHAPTER: Craniosynostosis: Endoscopically Versus Open Treatment

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