Spring-Assisted Surgery in the Treatment of Complex Craniosynostosis

• Published in: The Journal of craniofacial surgery Vol. 29; no. 4; p. 920
• Main Authors: Bevilacqua, Ruggero, Tarnow, Peter, Kölby, Lars, Maltese, Giovanni
• Format: Journal Article
• Language: English
• Published: United States 01.06.2018
• Subjects: Child, Preschool; Cohort Studies; Craniosynostoses - surgery; Female; Humans; Infant; Male; Reconstructive Surgical Procedures - methods; Reoperation; Tomography, X-Ray Computed
• ISSN: 1536-3732
• DOI: 10.1097/SCS.0000000000004377

Multisutural nonsyndromic craniosynostosis is a rare group of malformations, whose frequency has been reported between 3% and 7% of all craniosynostosis. The clinical diagnosis can be difficult and computed tomography is usually required. Surgical treatment is challenging and staged procedures are performed in up to 80% of patients. The aim of the present study was to determine the reoperation rate and to evaluate the surgical outcomes by measuring intracranial volume (ICV) preoperatively and at follow-up, and comparing it to a control group. Perioperative variables and reoperation rate were recorded. Fifty-one patients presented with a complex pattern of synostosis without a recognizable syndrome (5% of cases of total patients evaluated). Fifteen patients have been treated with spring-assisted surgery, either alone or in combination with a foreheadplasty. The mean follow-up was 6.2 years. The mean preoperative ICV of the patients was smaller, but not significantly, than in the normal population (P = 0.13). Postoperatively, the mean ICV was similar to that of the control group at 1 year (P = 0.92), while at 3 years it was appreciably smaller, although not significantly different (P = 0.06). Five patients (33%) went through a secondary skull expansion for either raised intracranial pressure or cosmetic reasons. Spring-assisted surgery seems to temporarily expand ICV in children with complex synostosis and lower the reoperation rate, thus reducing the need for a second procedure. A longer follow-up would be necessary to further investigate the effects of springs over time.