Spring-assisted cranioplasty for isolated sagittal craniosynostosis: a retrospective review

Abstract

Introduction: Premature fusion of the sagittal suture is the most common form of non-syndromic single-suture craniosynostosis. Surgical correction in infancy is recommended to normalise skull morphology and allow normal brain development, but the optimal approach is controversial. We present our experience with spring-assisted cranioplasty (SAC) for the management of isolated sagittal craniosynostosis. Methods: A retrospective review of 104 consecutive patients with isolated sagittal craniosynostosis managed with SAC at a tertiary referral craniofacial centre between 2008 and 2021. Results: Mean operative time was 63 minutes for spring insertion and 39 minutes for spring removal. Blood transfusion was required in 52.9 per cent of patients, with a mean total volume of 80.3 mL. The complication rate was 22.1 per cent, with spring exposure in two patients (1.9%) and surgical site infection requiring early spring removal in four patients (3.8%). Mean spring expansion was 2.89 cm anteriorly and 3.12 cm posteriorly. Revision vault expansion was required in four patients (3.8%), due to interval development of other synostosis (n = 2), raised intracranial pressure (n = 1), and interval development of other synostosis with raised intracranial pressure (n = 1). Conclusions: Isolated sagittal craniosynostosis can be safely and effectively managed using SAC, with short operative times and hospital stays, manageable associated complications and acceptable long-term outcomes.