Best-Practice Perioperative Optimization for Craniosynostosis Surgery

Abstract

Perioperative optimization in craniosynostosis surgery demands coordinated attention across the preoperative, intraoperative, and postoperative periods, yet considerable practice variation persists across craniofacial centers. Surgical approaches range from minimally invasive endoscopic strip craniectomy to open cranial vault reconstruction, each with distinct perioperative requirements and recovery trajectories. This chapter presents an evidence-based framework addressing the full perioperative continuum, beginning with preoperative risk stratification, hematologic optimization using erythropoietin, iron supplementation, and directed blood donation, and continuing through intraoperative blood conservation strategies, including tranexamic acid, cell salvage, and topical hemostasis. Antibiotic prophylaxis and targeted staphylococcal decolonization are reviewed alongside temperature management and venous embolism prevention. Postoperative considerations include multimodal analgesia, perioperative corticosteroid use, intensive care unit (ICU) disposition criteria, wound care, and expected length of stay by procedure type. Syndromic craniosynostosis is addressed as a distinct entity requiring heightened perioperative vigilance. A structured evidence-graded summary table accompanies the chapter as a practical clinical reference.