Anesthesia for Endoscopic Strip Craniectomy Repair: A Single-Center Retrospective Cohort Study

Abstract

Background and Objective: Endoscopic strip craniectomy is a minimally invasive surgical technique offered to infants for craniosynostosis repair. We examine our institution's experience with infants undergoing this surgery with respect to perioperative physiological parameters, transfusion rates, complications, and length of hospital stay. Methods: We performed an observational retrospective review of all infants undergoing endoscopic strip craniectomy at Great Ormond Street Hospital, UK from 2019 to 2024. Data were collected via the digital health record system EPIC (Epic Systems Corporation [2023], USA) and analyzed in Microsoft Excel. Results: One hundred and eleven patients were included in the study undergoing single or multicranial suture repair: metopic (n = 67), unicoronal (n = 27), sagittal (n = 9), frontosphenoidal (n = 2), bicoronal (n = 4), and multisuture (n = 2). We present a mean age of 4.4 months (±1.05 SD), weight 6.95 kg (±1.05 SD), male (n = 66) population predominance, and ASA score from 1 to 3. Surgical procedure time was 73 min (±23 SD) across all sutures, with multisuture repair requiring a longer operative time of 96 min (±15 SD). The overall red cell transfusion rate was 1 in 5 children, with a higher incidence in those undergoing metopic suture repair (18/67, 26%). Mean preoperative and postoperative hemoglobin in the single suture repair group was 114 g/L (±11 g/L SD) and 87 g/L (±13 g/L SD) resulting in a mean reduction in hemoglobin of 26 g/L (±15 g/L SD). Mean preoperative and postoperative hemoglobin in the bilateral or multisuture repair group was 118 g/L (±7.17 g/L SD) and 85.5 g/L (±14.29 g/L SD) resulting in a mean reduction in hemoglobin of 35 g/L (±15 g/L SD). One hundred and six infants (95%) were discharged on Day 1 postoperatively, and no children required high dependency care. Complications reported were inadvertent extubation on positioning (n = 2), laryngospasm (n = 1), and a minor transfusion reaction (n = 1). Conclusion: Endoscopic strip craniectomy is a well-established minimally invasive surgical technique. Anesthesia for this procedure is typically performed in young infants who may be at greater risk of perioperative anesthetic complications and clinically significant blood loss and blood transfusion. We report a > 20% transfusion rate in our infant cohort mostly with metopic repairs.