Introduction: Spring mediated cranioplasty, first introduced by Lauritzen in 1999, has demonstrated promising outcome results for the treatment of craniosynostosis. The purpose of this study is to assess the clinical outcome of this treatment modality, in comparison to historical controls, treated with standard cranial expansion techniques.
Material and Methods: Children, between the age of 3 and 6 months, diagnosed and undergoing treatment for scaphocephaly were considered for this study. This is an IRB approved study requiring parental consent for enrollment. Eight children, 3 females and 8 males, have been enrolled in this study to date. All study patients underwent cranial surgery including the removal of a 1.5 cm strip of midline calvarium including the sagittal suture. After this limited craniectomy, two 1.2 mm thick stainless steel omega shaped expanders (springs) were placed. All patients had preoperative and postoperative skull films to measure cranial expansion. Indices calculated include cephalic index, length ratio, width ratio, and height ratio.
Results: All children successfully underwent spring-mediated cranioplasty. There were no perioperative morbidities or mortalities associated with any of the surgical procedures. No secondary surgeries for infection or skin breakdown were required. The mean age at initial operation was 4.1 months. No transfusions were required for any of the study patients and the mean operative time was 45 minutes for spring placement. The mean hospital stay for the initial procedure was 36 hours. The second outpatient operative procedure to remove the springs was done at a mean age of 8 months, without any peri-operative squeal. The mean operative time for the second procedure was 25 minutes with a mean hospital stay of 21 hours. Serial follow-up skull films showed a mean maximal spring expansion of 7.1 cm. The mean cephalic index postoperatively was 75%, which compares favorably to published normal age matched historical controls treated with cranial expansion techniques.
Conclusion: The preliminary data supports this minimally invasive procedure as an effective treatment for scaphocephaly. Additional long-term outcome analysis of clinical morphology and development is ongoing.
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