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Background: High annual surgical caseloads have been considered essential for patient safety in craniosynostosis care. We evaluated perioperative outcomes over the first 12 years of experience in a national reference center for pediatric craniofacial surgery-a period characterized by a gradual increase in surgical volume.

Methods: All transcranial surgeries for craniosynostosis between 2012 and 2023 were included. Data were obtained from a local quality registry and electronic medical records. Perioperative complications, adverse events, and outlier outcomes occurring within 30 days postoperatively were recorded, categorized, and graded according to the Oxford Grading Scale (OGS). Bench-marking was performed using historical data from the Pediatric Craniofacial Collaborative Group (PCCG). Univariate and multivariate regression were used to analyze explanatory factors to complications and adverse events.

Results: A total of 322 transcranial craniosynostosis surgeries were performed with an overall complication rate of 6.8%. There were no severe complications of Grade 4 or 5% and 68% (15/ 22) of all complications were OGS Grade 1. Outcomes compared favorably with the PCCG benchmark data. Higher complication rates were observed in patients with craniofacial syndromes and surgical complications were more frequent in calvarial remodeling procedures compared to less invasive surgeries.

Conclusion: The overall complication rate was low and compared favorably with previously published results, including those from centers with longer experience and higher surgical volumes. These findings suggest that safe and effective craniosynostosis care can be achieved during the buildup phase of a specialized center, provided robust multidisciplinary structures and protocols are in place. 

BACKGROUND: Patients with complex shunt-related problems and varying diagnoses of cerebrospinal fluid (CSF) disturbance can present with headache and clinical symptoms that may be difficult to relate to underdrainage or overdrainage. Telemetric intracranial pressure (ICP) monitoring may assist in evaluating individual patients and assessing shunt function and adjustment. We report a case series of patients receiving a Miethke M.scio sensor.

METHODS: Between June 2016 and August 2021, 14 patients older than 18 years with different diagnoses underwent ventriculoperitoneal shunt surgery and received a Miethke M.scio sensor.

RESULTS: Patients had idiopathic intracranial hyper-tension (n = 3), obstructive hydrocephalus caused by tumors (n = 4), and malformations (n = 5). Headaches (71%) and visual impairment (50%) were the most common symptoms before surgery and 65% of the symptoms were improved after surgery. In total, 25 measurements were made and 11 of these led to changes in the shunt settings. Postoperative measurements were taken in 8 patients and the most common indication of ICP measurement was headache and/or control of the shunt settings.

CONCLUSIONS: The Miethke M.scio is a safe and valuable device to use in shunt-treated patients, in particular those expected to need assessment of ICP monitoring postoperatively. Repeated ICP measurements can also assist in personalized adjustment of the shunt setting to optimize CSF flow in this diverse patient group. Future studies should include a standardized protocol with ICP measurements correlated to the symptoms and cause of CSF disturbances to provide better understanding of the dynamics of the ICP in each patient.