Recognized for leading-edge work with craniofacial and pediatric plastic surgery, Arkansas Children's has expanded the range of advanced surgical methodologies and blood loss prevention modalities. These developments significantly improved long-term outcomes for patients with craniosynostosis.
“We focus primarily on reconstructive opportunities for children with a diagnosis of craniosynostosis,” said Sagar Mehta, M.D., director of Craniofacial Surgery and Pediatric Plastic Surgery at Arkansas Children’s Hospital and assistant professor in the Division of Pediatric Plastic and Reconstructive Surgery at the University of Arkansas for Medical Sciences (UAMS). “We’re committed to providing the best care possible while treating their complex anomalies and guiding their families through those surgical processes.”
For craniosynostosis patients diagnosed with the condition by four months of age, the Arkansas Children's Hospital team has pioneered a new surgical technique, the modified fronto-orbital advancement performed endoscopically for metopic suture synostosis. The technique has shown consistent and positive long-term patient outcomes.
"Not only do we make cuts to remove the diseased suture, but we also make cuts at the cranial base to expand out the skull bone to the appropriate size and shape," Dr. Mehta said. "Over the course of 15 procedures, we found the results associated with cutting into the cranial base at the time of the metopic suture are really quite impressive."
Arkansas Children's Hospital is home to the only surgical team nationwide to perform this technique by taking this approach. Along with novel treatment methodologies, traditional procedures such as the endoscopic strip craniectomy and cranial vault reconstruction for older patients are still offered.
"We perform many of these procedures through a minimally invasive process, and postoperatively we utilize helmeting and cranial springs to alleviate pressure on the brain and to improve the shape of the skull," Dr. Mehta said. "We've found cranial springs are often a viable alternative to helmeting for families who have greater challenges accessing helmet resources close to home."
To support surgical advancements in craniosynostosis treatment, quality improvement research on blood loss during these procedures further boosts patient outcomes.
"My goal when I arrived at Arkansas Children's was to address significant concern around performing these types of procedures because of the amount of blood volume patients would lose through the surgical process," Dr. Mehta said. "We've really done an awesome job of reducing blood loss and created a significant reduction in the number of patients who require blood transfusions."
One primary method for reducing blood loss consists of injecting intravenous fibrinolytic agent along with other agents throughout the skull and scalp.
"Traditionally, about 95% of patients who underwent craniosynostosis surgery received blood transfusions," Dr. Mehta said. "Using these techniques, we are able to prevent patients from requiring any blood transfusions at all. Approximately 75% to 80% of our patients who receive craniosynostosis surgery don't require blood transfusion."
Looking to the future, the team’s focus extends beyond treatment to include developmental interventions.
"Craniosynostosis was initially identified as a disease process and many insurance companies considered it an aesthetic procedure," Dr. Mehta said. "Today, more and more literature recognizes the fact that these early fusions of the skull's growth plate cause pressure on the brain and can significantly affect neurodevelopment."
Using advanced medical imaging, providers can use quantifiable data to support their interventions as they formulate a standard of care for craniosynostosis. Arkansas Children's providers are privileged to participate not only in providing advanced surgical techniques, but also in the quest to define the parameters of childhood neurological diseases and further refine existing standards of care.
"This career is really rewarding because it involves hands-on care of children," Dr. Mehta said. "You get to see the positive impact the work you've done has for that patient and their family as they continue to grow."
