Spring-Assisted Cranioplasty for the Correction of Nonsyndromic Scaphocephaly: A Quantitative Analysis of 100 Consecutive Cases.
BACKGROUND
Spring-assisted cranioplasty has been proposed as an alternative to total calvarial remodeling for sagittal craniosynostosis. Advantages include its minimally invasive nature, and reduced morbidity and hospital stay. Potential drawbacks include the need for a second procedure for removal and the lack of published long-term follow-up. The authors present a single-institution experience of 100 consecutive cases using a novel spring design.


METHODS
All patients treated at the authors' institution between April of 2010 and September of 2014 were evaluated retrospectively. Patients with isolated nonsyndromic sagittal craniosynostosis were included. Data were collected for operative time, anesthetic time, hospital stay, transfusion requirement, and complications in addition to cephalic index preoperatively and at 1 day, 3 weeks, and 6 months postoperatively.


RESULTS
One hundred patients were included. Mean cephalic index was 68 preoperatively, 71 at day 1, and 72 at 3 weeks and 6 months postoperatively. Nine patients required transfusion. Two patients developed a cerebrospinal fluid leak requiring intervention. One patient required early removal of springs because of infection. One patient had a wound dehiscence over the spring and one patient sustained a venous infarct with hemiplegia. Five patients required further calvarial remodeling surgery.


CONCLUSIONS
The authors' modified spring design and protocol represents an effective strategy in the management of single-suture sagittal craniosynostosis with reduced total operative time and blood loss compared with alternative treatment strategies. In patients referred within the first 6 months of birth, this technique has become the authors' procedure of choice. In a minority of cases, especially in the older age groups, further remodeling surgery is required.


METHODS
Therapeutic, IV.
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Will
W
Rodgers
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Graeme E
GE
Glass
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Silvia
S
Schievano
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Alessandro
A
Borghi
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Naiara
N
Rodriguez-Florez
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Arpan
A
Tahim
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Freida
F
Angullia
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
William
W
Breakey
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Paul
P
Knoops
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Maik
M
Tenhagen
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Justine
J
O'Hara
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Allan
A
Ponniah
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
Gregory
G
James
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
David J
DJ
Dunaway
London, United Kingdom.|From the Department of Craniofacial Surgery, Great Ormond Street Hospital for Children; the UCL Great Ormond Street Institute of Child Health; the Department of Oral and Maxillofacial Surgery, The Royal London Hospital; and the Department of Oral and Maxillofacial Surgery, The Royal Free Hospital.
N U Owase
NUO
Jeelani
D003398:Craniosynostoses / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*