Calvarial remodelling surgery: Neurosurgical experience of multidisciplinary craniofacial reconstruction

Objective: to evaluate the safety,cosmetic and functional outcome of craniofacial reconstruction surgery for primary craniosynostosis and clefts. methods: this quasi-experimental study was conducted at the combined military hospital,rawalpindi,pakistan,from june 2011 to december 2014,and comprised paediatric patients undergoing calvarial reconstructive procedures. fronto-orbital advancement and reconstruction,total calvarial remodelling and box flap reconstruction techniques were used. parameters recorded were anomaly,procedure,hospital and intensive care unit stay,theatre time,blood transfusion,dural tears,mortality,wound infection,haematoma/seroma,dehiscence,seizures and cosmetic acceptance. data was analysed using spss 17. results: of the 45 patients,24(53.3%) were boys and 21(46.7%) were girls with an overall mean age of 14.1±21.95 months. besides,36(80%) patients were operated for craniosynostosis and 9(20%) for tessier clefts. surgical techniques of fronto-orbital advancement and reconstruction,total calvarial remodelling and box flap were used on 18(40%),18(40%) and 9(20%) patients,respectively. the mean theatre time was 315.33±74.67 minutes (range: 240-390minutes). the mean blood transfusion was 313.34±135.84ml (range: 200-600ml). major wound infection was seen in 1(2.2%) patient and minor wound infection occurred in 6(13.3%) cases. post-operative seizures were seen in 1(2.2%). improved appearance and stable head growth were seen in 41(91.1%) patients. only 1(2.2%) patient did not survive the procedure. conclusion: early detection of craniosynostosis,neurological assessment,radiological evaluation,differentiating between primary and secondary craniosynostosis and multidisciplinary treatment of craniofacial reconstruction led to optimal treatment. © 2016,pakistan medical association. all rights reserved.