Minimizing blood transfusions in the surgical correction of coronal and metopic craniosynostosis

Steinbok, Paul; Heran, Navraj S.; Hiçdönmez, Tufan; Cochrane, D. Douglas; Price, Angela V.

doi:10.1007/s00381-004-0972-9

Cited by 33 publications

(33 citation statements)

References 29 publications

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“…There was also a significant, positive correlation between individual measures of EBL versus CBL for each patient. Our results differed from the reports of Faberowski and colleagues 1 and Steinbok et al, 7 who reported gross underestimation (30%Y66%) of CBL using EBL.…”

Section: Discussioncontrasting

confidence: 84%

Blood Loss Estimation During Fronto-Orbital Advancement

Seruya¹,

Oh²,

Rogers³

et al. 2012

Journal of Craniofacial Surgery

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Section: Discussioncontrasting

confidence: 84%

Blood Loss Estimation During Fronto-Orbital Advancement

Seruya¹,

Oh²,

Rogers³

et al. 2012

Journal of Craniofacial Surgery

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“…Although blood loss has been considered universally acceptable for complex craniofacial procedures, 13 Steinbok et al reported that with simple intraoperative techniques and acceptance of low postoperative hemoglobin levels transfusion rates could be kept low without compromising patient safety. 29 This approach combined with our technique resulted in a low blood transfusion rate.…”

Section: Operative Parametersmentioning

confidence: 88%

The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis

Seal¹,

Steinbok

Courtemanche³

2015

FOC

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OBJECT Current craniosynostosis procedures can result in complications due to absorbable plates and screws or other specialized expensive hardware. The authors propose the cranial orbital buttress (COB) technique of frontoorbital remodeling for metopic and unicoronal synostoses, wherein no plates or screws are used. They hypothesize that, with this technique, aesthetically acceptable outcomes for unicoronal and metopic synostosis can be achieved. In this article, they present this technique and compare the results with current frontoorbital remodeling practices. METHODS The authors conducted a retrospective chart review of cases in which patients with nonsyndromic unicoronal or metopic synostosis underwent cranio-orbital surgery at their institution from 1985 through 2009. Operative parameters, surgical variations, and complications were analyzed. The COB technique uses a 1-piece switch, hemiforeheads, or multiple pieces for forehead remodeling. The supraorbital bar is reconstructed in patients with metopic synostosis using a double wedge or greenstick fracture technique, and in patients with unicoronal synostosis a hinge procedure based on a 1.5-orbital osteotomy is used. The supraorbital bar is advanced and supported in place by bone graft(s) inserted at the lateral aspect(s) of the orbit(s) to form a buttress, with fixation done using absorbable sutures. RESULTS A total of 79 cases met the criteria for inclusion in the study. Twenty-nine patients had metopic synostosis, 3 had combined metopic and sagittal synostoses, and 47 had unicoronal synostosis. The patients’ mean age at surgery was 11.4 ± 10.1 months and the mean operative time was 183.4 ± 41.0 minutes. The mean length of hospital stay was 3.7 ± 1.2 days. The mean blood loss was 150.0 ± 125.6 ml, and 33% of patients required a blood transfusion (mean volume 206.9 ± 102.3 ml). In metopic synostosis, hemiforeheads were used most often (24/29, 83%), and the supraorbital bar was remodeled using a bilateral intracranial orbital osteotomy followed by a double wedge modification (23/29, 79%) or a greenstick fracture (4/29 14%) for milder cases. Forehead remodeling for unicoronal synostosis was by a forehead switch (39/47, 83%) and the supraorbital bar was remodeled using a 1.5-orbital intracranial orbital osteotomy (34/47, 72%) such that the bar was advanced on the abnormal side and hinged at the midline of the normal orbit. Perioperative complications occurred in 19% of cases and included dural tears (16%), inconsequential subdural hematoma (1.3%), and nasal greenstick fracture (1.3%). The total reoperation rate was 7.6% (cranioplasties for irregular contours, 6.3%; scar revision, 1.3%). CONCLUSIONS The COB remodeling technique is simple and efficient, gives acceptable outcomes, and is less resource intensive than previous techniques reported in the literature.

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“…As there is no increase in intracranial pressure, craniosynostosis surgery is performed in the first 3-6 months of life; in patients who will benefit from a barrel stave osteotomy, it is most appropriate to postpone the surgery to 5-6 months of age. In the study of Dahmani et al (5), which included 41 patients diagnosed with craniosynostosis, the mean age was 7.2 months; in the study of Steinbok et al (23), including 32 cases, the mean age was 8.3 months. In the current study, the mean age was 7.4 months, in accordance with the literature.…”

Section: █ Discussionmentioning

confidence: 99%

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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Minimizing blood transfusions in the surgical correction of coronal and metopic craniosynostosis

Abstract: Low transfusion rates were achieved in primary operations for coronal and metopic craniosynostosis using simple intraoperative techniques and by accepting a low postoperative hemoglobin level.

Cited by 33 publications

References 29 publications

Blood Loss Estimation During Fronto-Orbital Advancement

Blood Loss Estimation During Fronto-Orbital Advancement

The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis

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

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