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

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Sagittal craniosynostosis has been treated using both cranial remodeling techniques and modification of the sagittal strip craniectomy. A more recent technique is to implant springs in conjunction with a suturectomy to transversely expand the parietal bones to accommodate the growing brain. In this paper the authors describe and evaluate several modifications to the spring-mediated cranioplasty (SMC) technique, most notably use of an ultrasonic scalpel to limit dural dissection and maximize opening of the stenosed suture by placement of multiple spring devices. In addition, the literature is reviewed comparing SMC to other surgical treatments of sagittal synostosis.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors retrospectively reviewed patients who presented to the Children’s Hospital of Philadelphia with a diagnosis of sagittal synostosis from August 2011 to November 2014. A pooled data set was created to compare our institutional data to previously published work. A comprehensive literature review was performed of all previous studies describing the SMC technique, as well as other techniques for sagittal synostosis correction.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Twenty-two patients underwent SMC at our institution during the study period. Patients were 4.2 months of age on average, had a mean blood loss of 56.3 ml, and average intensive care unit and total hospital stays of 29.5 hours and 2.2 days, respectively. The cranial index was corrected to an average of 73.7 (SD 5.2) for patients who received long-term radiological follow-up. When comparing the authors’ institutional data to pooled SMC data, blood loss and length of stay were both significantly less (p = 0.005 and p &lt; 0.001, respectively), but the preoperative cranial index was significantly larger (p = 0.01). A review of the SMC technique compared with other techniques to actively expand the skull of patients with sagittal synostosis demonstrated that SMC can be performed at a significantly earlier age compared with cranial vault reconstruction (CVR).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The authors found that their institutional modifications of the SMC technique were safe and effective in correcting the cranial index. In addition, this technique can be performed at a younger age than CVRs. SMC, therefore, has the potential to maximize the cognitive benefits of early intervention, with lower morbidity than the traditional CVR.</jats:p></jats:sec>

Cranial bone structure in children with sagittal craniosynostosis: Relationship with surgical outcomes

“…One of the factors that is known to favour larger changes in CI is the age of the patient, with younger patients found to benefit more from SAC, presumably because of their skull being more malleable. 1,4,7,9 However, in our experience, age alone is not always an accurate predictor of the change in CI with SAC.…”

Statistical shape modelling to aid surgical planning: associations between surgical parameters and head shapes following spring-assisted cranioplasty

“…Spring-assisted cranioplasty is employed to correct the head shape of children with sagittal synostosis, who have long, narrow and sometimes bullet-like skulls wider anteriorly than posteriorly. SAC is a minimally invasive technique which relies on the gradual opening of spring-like distractors to push the skull to widen over time [ 36 – 38 , 56 ]. Due to the complex dynamic biomechanical remodelling, the effects of surgical choices (i.e.…”

Multidirectional Cranial Distraction Osteogenesis with Simplified Modifications for Treating Sagittal Synostosis

“…The procedures call for strip craniectomy, applying 2 or 3 springs across craniectomy edge. 9 , 10 However, surgeons cannot control distance or rate of advancement, and correction of bone deformities, such as frontal bossing. One-stage cranioplasty does offer good cosmetic results and is the mainstay procedure for treating sagittal synostosis.…”