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Evaluation of the Safety of Posterior Cranial Vault Reconstruction

Chen, Elliott H. M.D.; Gilardino, Mirko S. M.D., M.Sc.; Whitaker, Linton A. M.D.; Bartlett, Scott P. M.D.

Plastic and Reconstructive Surgery: March 2009 - Volume 123 - Issue 3 - p 995-1001
doi: 10.1097/PRS.0b013e318199f4b4
Pediatric/Craniofacial: Original Articles

Background: Posterior vault reconstruction involves exposure, craniotomy, and reconstruction of the occipital cranium. Although it is commonly performed, the safety and complications associated with posterior vault reconstruction have not been specifically or thoroughly examined.

Methods: A retrospective chart review was performed for all patients undergoing posterior vault reconstruction at the Children’s Hospital of Philadelphia between 1996 and 2006. Diagnosis, operative indication, age and weight at time of surgery, procedure type, intraoperative and postoperative complications, estimated blood loss, blood transfusion volume, and length of surgery and admission were recorded.

Results: Fifty posterior vault reconstruction cases were included in the study (17 syndromic and 33 nonsyndromic). Mean estimated blood loss was 53.6 percent (range, 15.9 to 142.9 percent) of total blood volume and was statistically greater in syndromic patients (60.6 percent versus 50.0 percent; p = 0.038). Transfusion volume averaged 66.1 percent of total blood volume but was not statistically significant. Length of surgery and number of intraoperative complications were significantly elevated in the syndromic cohort (p = 0.007 and p = 0.037, respectively), whereas length of admission and number of postoperative complications were not. Complications were intraoperative in seven patients (14 percent) and postoperative in seven (14 percent), for an overall complication rate of 28 percent.

Conclusions: This is the largest series to date addressing the safety and complications of posterior vault reconstruction. In the authors’ experience, posterior vault reconstruction carries a higher risk of intraoperative complications and blood loss compared with that reported in the literature for other types of cranial vault reconstruction. In addition, syndromic patients were more likely than nonsyndromic patients to encounter intraoperative problems.

Cleveland, Ohio; and Philadelphia, Pa.

From Case Western Reserve, Children’s Hospital of Philadelphia, and the University of Pennsylvania.

Received for publication May 20, 2008; accepted September 14, 2008.

Presented at the XIIth Biennial International Congress of the International Society of Craniofacial Surgery, in Salvador, Bahia, Brazil, August 23 through 25, 2007.

Disclosure: The authors have no financial disclosures or commercial associations to report.

Scott P. Bartlett, M.D.; University of Pennsylvania; Children’s Hospital of Philadelphia; Wood Center, 1st Floor; 34th and Civic Center Boulevard; Philadelphia, Pa. 19104;

©2009American Society of Plastic Surgeons