Abstract
Purpose
Endoscopic-assisted craniosynostosis surgery is associated with less blood loss and shorter operative times as compared to open surgery. However, in infants who have low circulating blood volumes, the endoscopic approach is still associated with significant blood loss. A major source of blood loss is the bone that is cut during surgery. We discuss the novel use of an ultrasonic bone-cutting device for craniosynostosis surgery, which decreases bone bleeding. This device, which has primarily only been used for spine and skull base surgery, may help reduce blood loss in these infants.
Methods
All patients with single suture craniosynostosis who were operated on with the use of an ultrasonic bone-cutting device were identified. The information retrospectively recorded from patient charts included patient age, suture involved, blood loss, operative times, complications, preoperative hemoglobin, postoperative hemoglobin, length of hospital stay, and follow-up times.
Results
Thirteen patients (12 males, 1 female) underwent surgery with an ultrasonic bone-cutting device during the reviewed period. The average age (±standard deviation) of the patients was 11.8 (±1.6) weeks. Four patients had metopic synostosis and nine patients had sagittal synostosis. The average surgery time was 84 (±13) min. The median (interquartile range) blood loss was 20 (10–70) cc. No patients required blood transfusions. Three patients had dural tears.
Conclusion
We demonstrate the novel use of an ultrasonic bone-cutting device for endoscopic-assisted craniosynostosis surgery. This device limited blood loss while maintaining short operative times for infants with low circulating blood volumes.
Similar content being viewed by others
References
Barone CM, Jimenez DF (1999) Endoscopic craniectomy for early correction of craniosynostosis. Plast Reconstr Surg 104:1965–1973, discussion 1974–1965
Barone CM, Jimenez DF (2004) Endoscopic approach to coronal craniosynostosis. Clin Plast Surg 31:415–422, vi
Berry-Candelario J, Ridgway EB, Grondin RT, Rogers GF, Proctor MR (2011) Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis. Neurosurg Focus 31:E5
Beziat JL, Bera JC, Lavandier B, Gleizal A (2007) Ultrasonic osteotomy as a new technique in craniomaxillofacial surgery. Int J Oral Maxillofac Surg 36:493–500
Bruggers S, Sindwani R (2009) Evolving trends in powered endoscopic sinus surgery. Otolaryngol Clin North Am 42:789–798, viii
Cartwright CC, Jimenez DF, Barone CM, Baker L (2003) Endoscopic strip craniectomy: a minimally invasive treatment for early correction of craniosynostosis. J Neurosci Nurs 35:130–138
Jimenez DF, Barone CM (1998) Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg 88:77–81
Jimenez DF, Barone CM, Cartwright CC, Baker L (2002) Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy. Pediatrics 110:97–104
Jimenez DF, Barone CM (2007) Early treatment of anterior calvarial craniosynostosis using endoscopic-assisted minimally invasive techniques. Childs Nerv Syst 23:1411–1419
Jimenez DF, Barone CM (2010) Endoscopic techniques for craniosynostosis. Atlas Oral Maxillofac Surg Clin North Am 18:93–107
Johnson JO, Jimenez DF, Barone CM (2000) Blood loss after endoscopic strip craniectomy for craniosynostosis. J Neurosurg Anesthesiol 12:60
MacKinnon S, Rogers GF, Gregas M, Proctor MR, Mulliken JB, Dagi LR (2009) Treatment of unilateral coronal synostosis by endoscopic strip craniectomy or fronto-orbital advancement: ophthalmologic findings. J Aapos 13:155–160
Marchac D, Renier D, Broumand S (1994) Timing of treatment for craniosynostosis and facio-craniosynostosis: a 20-year experience. Br J Plast Surg 47:211–222
Mehta VA, Bettegowda C, Jallo GI, Ahn ES (2010) The evolution of surgical management for craniosynostosis. Neurosurg Focus 29:E5
Meier PM, Goobie SM, DiNardo JA, Proctor MR, Zurakowski D, Soriano SG (2011) Endoscopic strip craniectomy in early infancy: the initial five years of anesthesia experience. Anesth Analg 112:407–414
Persing J, Babler W, Winn HR, Jane J, Rodeheaver G (1981) Age as a critical factor in the success of surgical correction of craniosynostosis. J Neurosurg 54:601–606
Proctor MR (2012) Endoscopic cranial suture release for the treatment of craniosynostosis—is it the future? J Craniofacial Surg 23:225–228
Riley AA, Arakawa Y, Worley S, Duncan BW, Fukamachi K (2010) Circulating blood volumes: a review of measurement techniques and a meta-analysis in children. ASAIO J 56:260–264
Shah MN, Kane AA, Petersen JD, Woo AS, Naidoo SD, Smyth MD (2011) Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children’s Hospital experience. J Neurosurg Pediatr 8:165–170
Tessier P (1971) Relationship of craniostenoses to craniofacial dysostoses, and to faciostenoses: a study with therapeutic implications. Plast Reconstr Surg 48:224–237
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chaichana, K.L., Jallo, G.I., Dorafshar, A.H. et al. Novel use of an ultrasonic bone-cutting device for endoscopic-assisted craniosynostosis surgery. Childs Nerv Syst 29, 1163–1168 (2013). https://doi.org/10.1007/s00381-013-2043-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-013-2043-6