Benefit of Piezoosteotomy in Cranioplasties for Craniosynostosis Correction versus Conventional Saw-and-Chisel Osteotomy: A Pilot Study

Abstract

Objective

Pilot study evaluation of the benefit of piezoosteotomy in cranioplasty of craniosynostoses, based on clinical data.

Design

Retrospective case-control study.

Setting

Universitarian institution.

Patients

Craniosynostosis patients (n = 19) operated upon conventionally with a craniotome and microsaw versus 19 patients operated upon with a piezoosteotomy and a craniotome.

Intervention

Piezoosteotomy of the supraorbital “bandeau” and osteotomies on part of the parietal and occipital regions versus conventional saw-and-chisel osteotomy.

Main Outcome Measures

Perioperative age, weight, laboratory parameters, transfusion and infusion requirements, operation time, and blood loss.

Results

The intraoperative erythrocyte concentrate transfusion and noncolloidal infusions were comparable (P = .15; P = .56). The fresh frozen plasma transfusion was significantly higher (P = .03); possibly, the anesthesiologist's reaction was secondary to the higher irrigation-fluid accumulation in the aspiration bag during piezoosteotomy. The postoperative erythrocyte concentrate transfusion rate was significantly lower (P = .01) as a result of local hemostasis in piezoosteotomy. The fresh frozen plasma transfusion and noncolloidal infusion volumes were nonsignificantly lower (P = .27; P = .85). Operation time was slightly shorter with a smaller standard deviation (P = .09), due to a lower rate of dural lacerations and consecutive repair; patients in the study group were on the intensive care unit half a day less (P = .73) than those in the control group. C-reactive protein was significantly lower preoperatively (P = .00) and on the operation day (P = .01) and nonsignificant postoperatively (P = .81); hematocrit was postoperatively higher (P = .23). Thrombocytes were preoperatively lower and postoperatively higher, both nonsignificant (P = .29; P = .52).

Conclusions

Piezoosteotomy appears to be less traumatic than conventional saw-and-chisel osteotomy by the evaluated parameters. The main study limitation is its nonrandomized retrospective design; results should be confirmed by a randomized controlled trial.