Spring-Mediated Cranioplasty Compared With the Modified Pi-Plasty for Sagittal Synostosis

Abstract

The aim of this study was to compare the safety, morphological outcome, and degree of parental satisfaction of the new spring-mediated cranioplasty with those of the modified pi-plasty in the management of sagittal synostosis. Ten patients with non-syndromic sagittal synostosis treated with the spring-mediated cranioplasty were followed prospectively. A control group of 10 sex-matched patients operated on with the modified pi-plasty procedure was chosen. Cephalometric radiographs were obtained preoperatively and postoperatively at 1 year of age. Cephalic index, axial width ratio, length ratio, width ratio and height ratio were used as objective measures of outcome. Parents were sent a questionnaire to obtain a subjective aesthetic assessment of outcome. Significantly less blood replacement was required (p = 0.003), and shorter duration of postoperative anaesthesia (p = 0.030) and postoperative hospital stay (p = 0.013) were found in the spring-mediated cranioplasty group. There were no complications or deaths in either group. Also significant was the inter-group difference in the postoperative change in the height ratio (p = 0.030), the most change being seen in the spring group. The change in the subjective parental aesthetic evaluation of skull shape was significant in both groups. In conclusion, the spring-mediated procedure was morphologically more effective than the modified pi-plasty procedure in the management of sagittal synostosis with the additional benefits of less blood transfusion needed and shorter duration of hospital stay.

Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

“…The initial postoperative CI of 75 or the 2-to 4-year postoperative CI of 73 was a good result, as compared with others. 2,4,6,12,15,18,22,23,[29][30][31][32]36,39,40,46,51 The decrease in CI that we observed over time is comparable to the limited available data on long-term outcome. 2,16 Adding a widening bridge complies with Fearon and colleagues' suggestion to overcorrect width to compensate for later growth restriction in that direction.…”

“…3,5,[9][10][11][12]15,17,[20][21][22][23][26][27][28][29][30][31][33][34][35][36]38,40,[43][44][45][46][47][48][49][50][51] The field continues to evolve and aims to reduce the impact of surgery. Minimally invasive approaches constitute the majority of recently detailed techniques.…”

Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review

“…For this data set, only the papers providing total number, mean, and standard deviation of the relevant factors were included for statistical analysis. 8,16,22,25,27 The cranial index was collected preoperatively using CT scans to report the ratio of maximal biparietal distance over maximal occipitofrontal distance multiplied by 100. Postoperatively, cephalograms were used to obtain the biparietal distance and occipitofrontal distance of patients who had springs implanted for more than 2 months.…”

“…Of those articles, 7 studies 3,4,8,17,22,25,27 were found that reported at least 5 cases of sagittal synostosis that were managed by SMC. The references of each paper were also reviewed to search for other relevant studies.…”

“…15 Since its introduction, spring-mediated treatment of sagittal synostosis has been evaluated at multiple institutions with reasonable results. 3,4,8,16,17,22,25,27 At the Children's Hospital of Philadelphia (CHOP), we use a modification of the spring-mediated cranioplasty (SMC) technique to treat sagittal synostosis without the prolonged use of an external orthosis. In this report we present our recent results of SMC, including our modifications of the technique.…”