title: Outcome analysis of our first 75 spring-assisted surgeries for scaphocephaly.
abstract: BACKGROUND
  Spring-assisted surgery (SAS) has demonstrated promising results for the treatment of sagittal craniosynostosis. The purpose of this study was to assess the outcomes of the first 75 cases compared with a prospectively collected group of patients treated with cranial expansion (cranial vault remodeling [CVR]).
  
  
  METHODS
  Seventy-five children with scaphocephaly have completed this institutional review board-approved study. Patients underwent cranial surgery with removal of a 1-cm strip of sagittal suture and insertion of a mean of 2 spring distractors. Clinical outcome assessment included analysis of changes in cephalic index, shape, and volume on three-dimensional laser scans for both the SAS and the CVR treatments. Perioperative variables for both techniques were also compared.
  
  
  RESULTS
  All patients successfully underwent SAS without significant complications with a mean follow-up of 46 months. Perioperative variables including odds ratio, time, blood loss, transfusion requirements, intensive care unit and hospital stay lengths, and hospital costs differed significantly in favor of SAS. The mean cephalic index improved from 69 preoperatively to 75.4 after SAS, comparable with the change from 66 to 72.5 for CVR. This correction was maintained at 3- and 5-year follow-ups. Anterior frontal bossing was corrected on three-dimensional scan volume measurements.
  
  
  CONCLUSIONS
  Spring-assisted surgery is a safe, effective, minimally invasive treatment of scaphocephaly. It combines the low morbidity and the operative time of a strip craniectomy with dynamic reshaping techniques while the implanted spring gradually distracts the skull, improving head shape. Our 7 years of experience has shown that SAS effectively corrected cranial shape including frontal bossing with maintained results over time.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Wake Forest University, Winston-Salem, North Carolina27157-1075, USA. ldavid@wfubmc.edu
authors.forename: Lisa R
authors.initials: LR
authors.lastname: David
authors.forename: Christina M
authors.initials: CM
authors.lastname: Plikaitis
authors.forename: Daniel
authors.initials: D
authors.lastname: Couture
authors.forename: Steven S
authors.initials: SS
authors.lastname: Glazier
authors.forename: Louis C
authors.initials: LC
authors.lastname: Argenta
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002508:Cephalometry; D003398:Craniosynostoses / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome