Possible Methods to Decrease Blood Loss in Surgical Management of Craniosynostosis

Abstract

Craniosynostosis represents a relatively common disorder, with an estimated prevalence of one in 2000 births. The cranial deformity is due to the premature fusion of the cranial sutures. The rapid growth of the brain during the first years of life results in compensatory skull deformation, which can lead to intracranial hypertension and subsequent neurobehavioral impairments. Primary operative repair during the first year of life is generally recommended, and most of these procedures are performed in children under 6 months when circulating blood volume is low. Therefore, relatively small blood losses can have a significant impact on hemodynamics and coagulation. The surgical correction of craniofacial malformations will often require blood transfusion during or after surgery. Due to legal and socioeconomic factors and ethical and religious practices, several strategies have has been proposed to reduce or avoid transfusions. Surgical correction of craniosynostosis can involve significant blood loss. Rates of allogenic blood transfusion have been reported to approach 100%. Multiple interventions have been described to reduce blood loss and transfusion requirements. Blood conservation methods Just as in adults, have been used in children to reduce allogeneic transfusion. The most extensively used surgical procedures have been cardiac surgery, liver transplant, scoliosis, and craniosynostosis. Many centers have adopted multiple methods to preoperatively optimize blood volume, decrease intraoperative blood loss, and modifying the transfusion thresholds via intraoperative or postoperative protocols.