title: Novel use of an ultrasonic bone-cutting device for endoscopic-assisted craniosynostosis surgery.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Kaisorn@jhmi.edu.|Department of Neurosurgery, The Johns Hopkins Hospital, Meyer 8-184, 600 North Wolfe Street, Baltimore, MD, 21202, USA. Kaisorn@jhmi.edu.
authors: Kaisorn L
authors: KL
authors: Chaichana
authors: Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: George I
authors: GI
authors: Jallo
authors: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Amir H
authors: AH
authors: Dorafshar
authors: Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Edward S
authors: ES
authors: Ahn
mesh_terms: D016063:Blood Loss, Surgical; D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D044583:Neuroendoscopy / Q000295:instrumentation* / Q000379:methods; D061646:Operative Time; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation* / Q000379:methods
chemical_list: D006454:Hemoglobins
keywords: Blood loss; Bone scalpel; Craniosynostosis; Endoscopic; Metopic; Piezoelectric; Piezosurgery; Sagittal; Ultrasonic bone cutting
references: Atlas Oral Maxillofac Surg Clin North Am. 2010 Sep;18(2):93-107
references: 21036312
references: Neurosurg Focus. 2010 Dec;29(6):E5
references: 21121719
references: J Neurosci Nurs. 2003 Jun;35(3):130-8
references: 12830660
references: J AAPOS. 2009 Apr;13(2):155-60
references: 19393513
references: Anesth Analg. 2011 Feb;112(2):407-14
references: 21156987
references: J Neurosurg. 1998 Jan;88(1):77-81
references: 9420076
references: Plast Reconstr Surg. 1971 Sep;48(3):224-37
references: 5566471
references: J Craniofac Surg. 2012 Jan;23(1):225-8
references: 22337414
references: J Neurosurg. 1981 May;54(5):601-6
references: 7014791
references: Plast Reconstr Surg. 1999 Dec;104(7):1965-73; discussion 1974-5
references: 11149758
references: Otolaryngol Clin North Am. 2009 Oct;42(5):789-98, viii
references: 19909859
references: J Neurosurg Anesthesiol. 2000 Jan;12(1):60
references: 10636624
references: Int J Oral Maxillofac Surg. 2007 Jun;36(6):493-500
references: 17382518
references: Clin Plast Surg. 2004 Jul;31(3):415-22, vi
references: 15219748
references: Pediatrics. 2002 Jul;110(1 Pt 1):97-104
references: 12093953
references: Childs Nerv Syst. 2007 Dec;23(12):1411-9
references: 17899128
references: J Neurosurg Pediatr. 2011 Aug;8(2):165-70
references: 21806358
references: Neurosurg Focus. 2011 Aug;31(2):E5
references: 21806344
references: Br J Plast Surg. 1994 Jun;47(4):211-22
references: 8081607
references: ASAIO J. 2010 May-Jun;56(3):260-4
references: 20335800