title: Comparison of spring-mediated cranioplasty to minimally invasive strip craniectomy and barrel staving for early treatment of sagittal craniosynostosis.
abstract: The treatment of sagittal craniosynostosis has evolved from early strip craniectomy to total cranial vault remodeling and now back to attempts at minimally invasive correction. To optimize outcomes while minimizing morbidity, we currently use 2 methods of reconstruction in patients younger than 9 months: spring-mediated cranioplasty (SMC) and minimally invasive strip craniectomy with parietal barrel staving (SCPB). The purpose of this study was to compare the safety and efficacy of the 2 methods. Hospital records of our first 7 SMCs and our last 7 SCPBs were analyzed for demographics, the type of operation performed, estimated blood loss, transfusion requirements, operative time, length of stay in the intensive care unit, length of hospital stay, preoperative cephalic index, postoperative cephalic index, and complications. The techniques were then compared using analysis of variance.All 14 patients successfully underwent cranial vault remodeling with significant improvement in cephalic index. Demographics, length of stay in the intensive care unit (P = 0.15), preoperative cephalic index (P = 0.86), and postoperative cephalic index (P = 0.64) were similar between SMC and SCPB. Spring-mediated cranioplasty had statistically significantly shorter operative time (P = 0.002), less estimated blood loss (P < 0.001), and shorter length of hospital stay (P = 0.009) as compared with SCPB. Complications included 1 spring dislodgment in an SMC that did not require additional management and 1 undercorrection in the SCPB group. Both SMC and SCPB are safe, effective means of treating sagittal craniosynostosis. Spring-mediated cranioplasty has become our predominant means of treatment of scaphocephaly in patients younger than 9 months because of its improved morbidity profile.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. jataylor@gmail.com
authors.forename: Jesse Adam
authors.initials: JA
authors.lastname: Taylor
authors.forename: Todd A
authors.initials: TA
authors.lastname: Maugans
mesh_terms: D001696:Biomechanical Phenomena; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001864:Bone Wires; D002508:Cephalometry / Q000706:statistics & numerical data; D003393:Cranial Sutures / Q000002:abnormalities* / Q000601:surgery; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D003422:Critical Care; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010294:Parietal Bone / Q000002:abnormalities* / Q000601:surgery; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D012449:Safety; D013314:Stress, Mechanical; D013997:Time Factors; D016896:Treatment Outcome