The ASCFS Clinical Practice Guideline for the Surgical Treatment of Craniosynostosis

Abstract

Background:

Craniosynostosis is a congenital condition characterized by the premature fusion of 1 or more cranial sutures, leading to abnormal skull and facial morphology. Despite significant advancements in its understanding and treatment, variability in clinical practice persists across perioperative care. This underscores the need for evidence-based guidelines to standardize care and improve patient outcomes. The American Society of Craniofacial Surgeons (ASCFS) aims to address this need by presenting a comprehensive clinical practice guideline for the perioperative surgical treatment of craniosynostosis.

Methods:

American craniofacial centers were surveyed for standardized perioperative care protocols for craniosynostosis. Key topics, including analgesia and preoperative imaging, formed the foundation of this guideline. Literature searches on PubMed and embase were conducted for each topic, with 2 reviewers independently screening titles and abstracts. A third-party reviewer resolved any discrepancies. Full-text reviews identified articles for inclusion. Recommendations were developed using an evidence-based consensus approach and graded using the American Society of Plastic Surgeons’ recommendation grading scale.

Results:

Recommendations were developed for 23 topics, including antimicrobial prophylaxis, analgesia, steroids, surgical drains, preoperative imaging, postoperative nausea and vomiting, and agents to manage blood loss such as tranexamic acid, epsilon-aminocaproic acid, and fibrinogen. The strength of recommendation to support these components was variable but allows for each institution to implement the aspects of the protocol that are suitable for their practice patterns in an evidence-based manner.

Conclusions:

This standardized perioperative clinical care pathway represents a synthesis of the current literature available to guide perioperative care of patients undergoing cranial vault repair for the treatment of craniosynostosis. These recommendations can be applied to most patients, although as with any clinical practice guideline, they should be guided by each patient’s clinical circumstances and individual institutional policies.