Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution

Rowland H. Han, Dennis C. Nguyen, Brent S. Bruck, Gary B. Skolnick, Chester K. Yarbrough, Sybill D. Naidoo, Kamlesh B. Patel, Alex A. Kane, Albert S. Woo, Matthew D. Smyth

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective 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.

Original languageEnglish (US)
Pages (from-to)361-370
Number of pages10
JournalJournal of Neurosurgery: Pediatrics
Volume17
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Craniosynostoses
Length of Stay
Blood Transfusion
Synostosis
Tranexamic Acid
Reoperation
Cohort Studies
Retrospective Studies
Erythrocytes
Steroids
Morbidity

Keywords

  • Craniofacial
  • Craniosynostosis
  • Endoscope
  • Minimally invasive
  • Surgical complications

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Han, R. H., Nguyen, D. C., Bruck, B. S., Skolnick, G. B., Yarbrough, C. K., Naidoo, S. D., ... Smyth, M. D. (2016). Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution. Journal of Neurosurgery: Pediatrics, 17(3), 361-370. https://doi.org/10.3171/2015.7.PEDS15187

Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution. / Han, Rowland H.; Nguyen, Dennis C.; Bruck, Brent S.; Skolnick, Gary B.; Yarbrough, Chester K.; Naidoo, Sybill D.; Patel, Kamlesh B.; Kane, Alex A.; Woo, Albert S.; Smyth, Matthew D.

In: Journal of Neurosurgery: Pediatrics, Vol. 17, No. 3, 01.03.2016, p. 361-370.

Research output: Contribution to journalArticle

Han, RH, Nguyen, DC, Bruck, BS, Skolnick, GB, Yarbrough, CK, Naidoo, SD, Patel, KB, Kane, AA, Woo, AS & Smyth, MD 2016, 'Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution', Journal of Neurosurgery: Pediatrics, vol. 17, no. 3, pp. 361-370. https://doi.org/10.3171/2015.7.PEDS15187
Han, Rowland H. ; Nguyen, Dennis C. ; Bruck, Brent S. ; Skolnick, Gary B. ; Yarbrough, Chester K. ; Naidoo, Sybill D. ; Patel, Kamlesh B. ; Kane, Alex A. ; Woo, Albert S. ; Smyth, Matthew D. / Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution. In: Journal of Neurosurgery: Pediatrics. 2016 ; Vol. 17, No. 3. pp. 361-370.
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abstract = "Objective 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.",
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N2 - Objective 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.

AB - Objective 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.

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