title: Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution.
abstract: OBJECT The authors present a retrospective cohort study examining complications in patients undergoing surgery for craniosynostosis using both minimally invasive endoscopic and open approaches. METHODS Over the past 10 years, 295 nonsyndromic patients (140 undergoing endoscopic procedures and 155 undergoing open procedures) and 33 syndromic patients (endoscopic procedures in 10 and open procedures in 23) met the authors' criteria. Variables analyzed included age at surgery, presence of a preexisting CSF shunt, skin incision method, estimated blood loss, transfusions of packed red blood cells, use of intravenous steroids or tranexamic acid, intraoperative durotomies, procedure length, and length of hospital stay. Complications were classified as either surgically or medically related. RESULTS In the nonsyndromic endoscopic group, the authors experienced 3 (2.1%) surgical and 5 (3.6%) medical complications. In the nonsyndromic open group, there were 2 (1.3%) surgical and 7 (4.5%) medical complications. Intraoperative durotomies occurred in 5 (3.6%) endoscopic and 12 (7.8%) open cases, were repaired primarily, and did not result in reoperations for CSF leakage. Similar complication rates were seen in syndromic cases. There was no death or permanent morbidity. Additionally, endoscopic procedures were associated with significantly decreased estimated blood loss, transfusions, procedure length, and length of hospital stay compared with open procedures. CONCLUSIONS Rates of intraoperative durotomies and surgical and medical complications were comparable between endoscopic and open techniques. This is the largest direct comparison to date between endoscopic and open interventions for synostosis, and the results are in agreement with previous series that endoscopic surgery confers distinct advantages over open surgery in appropriate patient populations.
authors.affiliation: Department of Neurological Surgery and.
authors.forename: Rowland H
authors.initials: RH
authors.lastname: Han
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine in St. Louis, Missouri; and.
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Nguyen
authors.affiliation: Department of Neurological Surgery and.
authors.forename: Brent S
authors.initials: BS
authors.lastname: Bruck
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine in St. Louis, Missouri; and.
authors.forename: Gary B
authors.initials: GB
authors.lastname: Skolnick
authors.affiliation: Department of Neurological Surgery and.
authors.forename: Chester K
authors.initials: CK
authors.lastname: Yarbrough
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine in St. Louis, Missouri; and.
authors.forename: Sybill D
authors.initials: SD
authors.lastname: Naidoo
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine in St. Louis, Missouri; and.
authors.forename: Kamlesh B
authors.initials: KB
authors.lastname: Patel
authors.affiliation: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Alex A
authors.initials: AA
authors.lastname: Kane
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University School of Medicine in St. Louis, Missouri; and.
authors.forename: Albert S
authors.initials: AS
authors.lastname: Woo
authors.affiliation: Department of Neurological Surgery and.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Smyth
mesh_terms: D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D008923:Missouri / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: EBL = estimated blood loss; EBV = estimated blood volume; PRBC = packed red blood cells; TXA = tranexamic acid; craniofacial; craniosynostosis; endoscope; minimally invasive; surgical complications