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DOI: 10.1055/s-0044-1786049
Modified Technique to Protect the Superior Sagittal Sinus in Cranial Vault Reconstruction for Scaphocephaly
Técnica modificada para proteger o seio sagital superior em reconstrução da calota craniana por escafocefalia
Abstract
Scaphocephaly remains the most prevalent form of isolated single-suture synostosis. In most Pediatric Neurosurgery Centers, the treatment consists of extensive calvarial reshaping operations which are performed in relatively late ages. We described a modified open technique of cranial vault reconstruction for scaphocephaly and we report the anesthetic approach and how it influences our results and enables the performance of this surgery at earlier ages. A total of 47 patients with an average age of 11 ± 2.72 months underwent to the same surgical technique. Blood transfusion during the surgical intervention was needed in 25 patients (53%), and 22 patients (46.8%) did not need blood transfusion. None of the 14 patients who used tranexamic acid (TXA) needed blood transfusions. We reported a statistically significant association between the use of TXA and blood transfusion (p < 0.0001), with a decreased need for blood transfusion with the use of TXA. Besides sagittal suturectomy, we create new parasagittal sutures by replacing the prematurely fused one, and 1.5 cm of the anterior segment of bone of those 2 rectangular structures are cut before fixation, to enable the immediate shortening of the anteroposterior (AP) diameter of the skull. Finally, we put a mesh plate (SonicWeld Rx, KLS Martin Group, Tuttlingen, Baden-Wuerttemberg, Germany) over the superior sagittal sinus (SSS), which is fixed anteriorly and posteriorly with pins (SonicPins Rx, KLS Martin Group). This procedure enables an immediate reduction of the AP diameter of the skull, with no further therapies needed, and promotes a wide decompression and remodeling of the skull. With an experienced surgical team and an anesthesiologic protocol, we were able to perform this surgery at early ages, requiring no blood transfusions.
Resumo
A escafocefalia continua sendo a forma mais prevalente de sinostose isolada de sutura única. Na maioria dos Centros de Neurocirurgia Pediátrica, o tratamento consiste em extensas operações de remodelação calvária, realizadas em idades relativamente tardias. Descrevemos uma técnica aberta modificada de reconstrução da calota craniana para escafocefalia e relatamos a abordagem anestésica e como ela influencia nossos resultados e permite a realização desta cirurgia em idades mais precoces. Um total de 47 pacientes com idade média de 11 ± 2,72 meses foram submetidos à mesma técnica cirúrgica. A transfusão sanguínea durante a intervenção cirúrgica foi necessária em 25 pacientes (53%) e 22 pacientes (46,8%) não necessitaram de transfusão sanguínea. Nenhum dos 14 pacientes que usaram ácido tranexâmico (TXA) precisou de transfusões de sangue. Relatamos uma associação estatisticamente significativa entre o uso de TXA e transfusão de sangue (p < 0,0001), com diminuição da necessidade de transfusão de sangue com o uso de TXA. Além da suturectomia sagital, criamos novas suturas parassagitais substituindo a fundida prematuramente, e 1,5 cm do segmento anterior do osso dessas duas estruturas retangulares são cortados antes da fixação, para permitir o encurtamento imediato do diâmetro ântero-posterior (AP) do crânio. Por fim, colocamos uma placa de tela (SonicWeld Rx, KLS Martin Group, Tuttlingen, Baden-Wuerttemberg, Alemanha) sobre o seio sagital superior (SSS), a qual é fixada anterior e posteriormente com pinos (SonicPins Rx, KLS Martin Group). Este procedimento permite uma redução imediata do diâmetro AP do crânio, sem necessidade de terapias adicionais, e promove ampla descompressão e remodelação do crânio. Com uma equipe cirúrgica experiente e um protocolo anestesiológico, conseguimos realizar esta cirurgia em idades precoces, sem necessidade de transfusões sanguíneas.
Institution Where the Work Was Conducted
The Neurosurgery Service at Centro Hospitalar Universitário do São João.
Publication History
Received: 02 July 2023
Accepted: 21 February 2024
Article published online:
26 April 2024
© 2024. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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