Optimizing Reconstruction in Craniosynostosis: A 12-Year Review of 162 Non-Syndromic Patients Treated with a Novel Technique

Purpose: Open cranial vault remodeling (CVR) with autologous split calvarial bone grafts redistributes and recontours an abnormal calvarium to create an expanded cranial vault in patients with craniosynostosis. We report a 12-year retrospective review of 162 non-syndromic patients who underwent operative repair using our previously-described technique which portends excellent surgical outcomes, maximizes operative efficiency, and decreases total blood loss with low revision and complication rates.

 

Methods: Data was gathered on patients who underwent cranial vault remodeling from 2005 to 2016. Surgical records for each patient were analyzed and included operative time, estimated blood loss, and intraoperative transfusion volumes. Intraoperative and post-operative complications, the need for revision surgery, post-operative length of stay and follow-up records were also reviewed. Syndromic patients were excluded, as well as patients with incomplete data sets. Patients who underwent either anterior or posterior vault remodeling were compared.

 

Results: A total of 162 patients were included in this study. Patients undergoing anterior CVR were significantly older than those undergoing posterior CVR (13.3 vs. 11.0 months, p<0.015) and also had significantly greater intraoperative red blood transfusion volumes (20.3 vs. 15.3cc/kg, p<0.0207) and longer operative time than posterior CVR patients (274.9 vs. 216.7 minutes p<.0001).  There were no significant differences between groups with regards to revision rate and complications. Calvarial bone was successfully split in 100% of cases.

 

Conclusions: This surgical approach to results in satisfactory surgical outcomes with a low recurrence rate, while also maximizing operative efficiency, and minimizing total blood loss and transfusion volume. This technique can be applied to any affected suture in a patient with craniosynostosis.