title: Safety of Open Cranial Vault Surgery for Single-Suture Craniosynostosis: A Case for the Multidisciplinary Team.
abstract: BACKGROUND
  Single Suture Craniosynostosis (SSC) occurs in 1 in 2,500 live births and is the most common type of craniosynostosis treated in most centers. Surgical treatment has evolved over the past century and open techniques are tailored to the specific suture type. Additionally, the concept of multi-disciplinary team care has proliferated and is becoming the standard of care for SSC. The combination of these evolutions, we believe, has improved the safety of cranial vault surgery for SSC.
  
  
  METHODS
  A retrospective review of patients participating in the Infant Learning Project at Seattle Children's Hospital who underwent cranial vault surgery for treatment of SSC between 2002 and 2006 was performed. Pre-operative assessment, surgical techniques, anesthetic and intraoperative events and both intra-operative and post-operative adverse events were analyzed.
  
  
  RESULTS
  Eighty eight patients fulfilled the inclusion criteria (42 sagittal, 23 metopic, 19 unicoronal, 4 lambdoid). Length of procedure varied (FOA 5.2 hrs, modified pi 2.5 hrs, total vault 4.9 hrs and switch cranioplasty 4.6 hrs), as did transfusion amount (FOA 385 mL, modified pi 216 mL, total vault 600 mL, switch cranioplasty 207 mL) although 99% of patients received a transfusion of some sort. There were no deaths and no major intraoperative complications. Minor events include; ET tube malposition (1), desaturation (1), acidosis (1), hypothermia (9), coagulopathy (2), Hct < 25 (55). Average hospital stay was 3.4 days with no major post-operative complications. One patient was readmitted to the ICU and 1 had a scalp hematoma, but no patients returned to the operating room within 6 months after surgery.
  
  
  CONCLUSIONS
  The surgical treatment of SSC has evolved from lengthy, risky procedures to become almost routine at most craniofacial centers. Additionally, the care for patients with SSC has evolved from a single provider to a multidisciplinary team concept based around protocols for workup, delivery of anesthesia, streamlined surgical procedures and post-operative care and assessment. This evolution has given open cranial vault surgery for SSC an acceptable safety profile.
authors.affiliation: Seattle Children's Hospital, Seattle, WA.
authors.forename: Craig B
authors.initials: CB
authors.lastname: Birgfeld
authors.forename: Lynette
authors.initials: L
authors.lastname: Dufton
authors.forename: Heather
authors.initials: H
authors.lastname: Naumann
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hopper
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Gruss
authors.forename: Charles M
authors.initials: CM
authors.lastname: Haberkern
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Speltz
mesh_terms: D001803:Blood Transfusion; D015331:Cohort Studies; D003393:Cranial Sutures / Q000601:surgery; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000601:surgery; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D009777:Occipital Bone / Q000601:surgery; D061646:Operative Time; D010294:Parietal Bone / Q000601:surgery; D010347:Patient Care Planning; D010348:Patient Care Team; D011183:Postoperative Complications; D011300:Preoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012449:Safety; D013701:Temporal Bone / Q000601:surgery