Current techniques and protocols in the surgical management of scaphocephaly in young infants.

ABSTRACT

BACKGROUND: Many techniques and protocols are currently used in the treatment of scaphocephaly worldwide, including total calvarial remodeling and minimally invasive strip craniectomies. This study reviews current techniques and protocols used in young infants (aged ≤ 6 months) as well as the outcomes in terms of reoperation rates. METHODS: A short questionnaire was designed including questions about the preferred surgical techniques, transfusion protocols, and reoperation rates. Surgeons from the International Society of Craniofacial Surgery and the International Society for Pediatric Neurosurgery were requested to respond to this questionnaire online or by e-mail. Responses during a 2-week period were collated and analyzed using Fisher exact test. RESULTS: A total of 91 surgeons responded from the craniofacial centers around the world, of which 93.4% completed the questionnaire. Most respondents were from North America and Europe (35% and 20%, respectively). The operative volume was less than 15 cases per year in 56%, and the bicoronal skin incision was most commonly used (81%). Postoperative drainage was not performed by 55% but was statistically more common with use of the bicoronal incision (P = 0.029). Of the respondents, 66% used calvarial remodeling, and 34% strip craniectomy. Blood was most commonly transfused at a hemoglobin level under 8 g/dL (31%), with a mean transfusion rate of 66%. Of the respondents, 44% transfused in more than 90% of the cases, whereas only 18% transfused in 20% or less of the cases. The mean reoperation rate for secondary fusion was 1.7%, and 41% of the respondents claimed a 0% reoperation rate. A statistically higher frequency of reoperation was reported by centers with a case load of more than 15 cases per year (P = 0.035), and no statistical correlation was found with the type of surgical technique. CONCLUSIONS: Our survey of neurosurgeons and craniofacial plastic surgeons worldwide shows that for young infants treated for scaphocephaly, the bicoronal incision is most commonly used and a greater number of surgeons do not use drains. A great variability in the transfusion protocols used in the care of these patients as well as a low reoperation rate were also found. The latter however may suggest a lack of strict monitoring in most centers. Overall, this study presents a snapshot of the current surgical treatment of this subset of patients and should serve as a basis for quality improvement and outcome monitoring in their surgical management.