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Cited by 64Craniofacial Disorders and TreatmentsPectus Deformity Diagnosis and TreatmentReconstructive Facial Surgery Techniques

Safety of Open Cranial Vault Surgery for Single-Suture Craniosynostosis: A Case for the Multidisciplinary Team

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Birgfeld, Craig B., Dufton, Lynette, Naumann, Heather, Hopper, Richard A., Gruss, Joseph S., Haberkern, Charles M., Speltz, Matthew L.·2015·Journal of Craniofacial Surgery
DOI 10.1097/scs.0000000000001940PMC PMC4610150
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Abstract

INTRODUCTION: 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. DISCUSSION: 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.

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  • Birgfeld et al. and Seruya et al. emphasized that multidisciplinary surgical planning is crucial for ensuring both safety and effectiveness of CVR.

    “In a more recent comparative study, Birgfeld et al. and Seruya et al. emphasised that multidisciplinary surgical planning is crucial in ensuring both the safety and effectiveness of CVR, underscoring the importance of postoperative monitoring to optimise long-term outcomes [44, 45].”

    From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [45]

    The Discussion (page unavailable) emphasizes multidisciplinary protocols and says the authors believe the team approach contributed to safety, but explicitly says the study cannot establish that team care is safer than care outside a team. The Introduction describes improved outcomes, and the postoperative-care section describes ICU monitoring; neither establishes that multidisciplinary planning ensures effectiveness or that monitoring optimizes long-term outcomes. (LLM, conf=0.88)

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2 of the 74 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [66]Friede H Lilja J The Eurocleft Study: Intercenter study of treatment outcome in patients with complete cleft lip and palate. Cleft Palate Craniofac J 2005 42 453 454 author reply 454 16001931
  2. [68]Rosenstein SW Grasseschi M Dado D The Eurocleft Study: Intercenter study of treatment outcome in patients with complete cleft lip and palate. Cleft Palate Craniofac J 2005 42 453 author reply 454 16001930

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Authors
Birgfeld, C. B., Dufton, L., Naumann, H., Hopper, R. A., Gruss, J. S., Haberkern, C. M., & Speltz, M. L.
Affiliations
Seattle Children's Hospital (US)
Corresponding author
Birgfeld, Craig B.
ORCID
Hopper, Richard A.
Venue
Journal of Craniofacial Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-10
Volume
26
Issue
7
Pages
2052-2058
ISSN
1049-2275 (ISSN-L)
DOI
10.1097/scs.0000000000001940
PMC
PMC4610150
OpenAlex
W2465275614
Cited by
64
References
74
Citations by year
2026: 8 · 2025: 6 · 2024: 7 · 2023: 3 · 2022: 6 · 2021: 7 · 2020: 5 · 2019: 10 · 2018: 6 · 2017: 4 · 2016: 2
FWCI
2.73
Type
journal article
Language
en
Open access
Locations
  • Journal of Craniofacial Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Dental and Craniofacial Research (R01DE013813)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
Keywords
single-suture craniosynostosis, surgical safety, sagittal craniosynostosis, metopic craniosynostosis, unicoronal craniosynostosis, lambdoid craniosynostosis, intraoperative complications, postoperative complications, multidisciplinary care
MeSH terms
Blood Transfusion, Cranial Sutures, Craniosynostoses, Craniotomy, Critical Care, Female, Follow-Up Studies, Frontal Bone, Humans, Infant, Intraoperative Care, Intraoperative Complications, Length of Stay, Male, Occipital Bone, Parietal Bone, Patient Care Planning, Patient Care Team, Postoperative Complications, Preoperative Care, Retrospective Studies, Safety, Temporal Bone, Cohort Studies, Plastic Surgery Procedures, Operative Time

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