All patients treated at our institution between April 2010 and September 2014 were evaluated retrospectively. Patients with isolated non-syndromic sagittal craniosynostosis were included. Data were collected for operative time, anaesthetic time, hospital stay, transfusion requirement and complications in addition to cephalic index pre-operatively and at one day, three weeks and six months post-operatively.
One hundred patients were included. Mean cephalic index was 68 pre-operatively, 71 at day 1 and 72 at 3 weeks and 6 months post-operatively. Nine patients required transfusion. Two patients developed a CSF leak requiring intervention. One patient required early removal of springs due to infection. One patient had a wound dehiscence over the spring and 1 patient sustained a venous infarct with hemiplegia. Five patients required further calvarial remodelling surgery.
Our 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 when compared to alternative treatment strategies. In patients referred within the first 6 months of birth this technique has become our procedure of choice. In a minority of cases especially in the older age groups further remodelling surgery is required 1).
Spring-assisted cranioplasty (SAC) has become an accepted treatment for patients with sagittal craniosynostosis; however, the early effects of springs on skull dimensions have never been assessed with objective measurements in the literature. The present study evaluated the changes in skull dimensions and intracranial volume (ICV) during the first 3 months after SAC for sagittal synostosis.
Sixteen patients with sagittal synostosis underwent SAC. The cephalic index (CI) and the distance between the spring foot plates were chronologically measured until spring removal at 3 months. Pre- and post-treatment CT scans available for 6 patients were used to assess changes in head shape. Thirteen patients underwent objective aesthetic assessment using pre- and post-operative photographs. Statistical analysis was performed using the linear mixed model for chronological data, t-test statistics for normative data comparisons and Wilcoxon's signed rank test for non-parametric data.
For scaphocephalic patients, pre-operative and post-operative CIs were 0.70 and 0.74 (p = 0.001), respectively. Cranial widening towards normative values was observed (p = 0.0005). A continuous expansion in the distance between the spring foot plates was observed over the treatment period. Frontal and occipital angles were not affected by SAC despite apparent clinical improvements in frontal bossing and occipital prominence. CT analysis demonstrated relative reduction in the anterior cranial volume (p = 0.01) and relative expansion of the superior occipital volume (p = 0.03).
Spring expansion was most marked in the hours following spring insertion. The expansion rate reduced to the minimum by day 1 post-operatively. Clinical benefits of SAC resulted from an increase in the bi-temporal width that camouflaged the frontal bossing. Improvement in occipital prominence was due to superior occipital volume expansion, allowing the occiput to remodel to a more rounded shape 2).