Perioperative Management of Pediatric Patients with Craniosynostosis

Craniosynostosis: Caring for Infants and Their Families

“…10,13,14 The goal of surgery via open craniectomy is to excise the fused suture and reconstruct the cranial vault to increase intracranial volume, avoid intracranial hypertension, and allow the brain to grow in a natural pattern. Complications of surgery 10,12,[15][16][17] are listed in Table 2. Although unlikely, stroke and even death can occur as a result of surgery.…”

“…33,34 Numerous techniques intended to reduce intraoperative blood loss during craniosynostosis surgery have been studied, including use of autologous blood obtained before surgery, short-term nomovolemic hemodilution, and intraoperative blood salvage. 12,15 Tranexamic acid is a synthetic antifibrinolytic drug that competitively decreases the activation of plasminogen to plasmin and suppresses fibrinolysis by inhibiting plasminogen and the binding of plasmin to fibrin. Tranexamic acid has been used to decrease intraoperative blood loss during cardiac surgery.…”

“…Oropharyngeal and laryngotracheal edema may exacerbate preexisting obstructive apnea in patients with syndromic craniosynostosis and may critically worsen an already difficult intubation for patients with midface deficits. 2,15 Patients are positioned with the head of the bed elevated, and pulse oximetry is used to monitor oxygen saturation.…”

“…Recontoured grafts may be placed and secured to the skull with absorbable plates and screws. 10,12,15,16,[29][30][31][32] A drain is left in place above the skull but is pierced through the scalp as the scalp is sutured back together with 2 layers of stitches.…”

The clinical picture of nonsyndromic craniosynostosis in children

“…Обращает внимание четкая тре-угольная деформация с вершиной в области глабеллы. Верхние и наружные края орбит смещаются кзади, что со-провождается разворотом плоскости орбит кнаружи и уменьшением межорбитального расстояния, возникает гипотелоризм [15]. Деформация настолько своеобразна, что дети с тригоноцефалией часто консультируются гене-тиками и наблюдаются как носители наследственных не-врологических синдромов.…”