Sunday, September 25, 2005 - 3:05 PM

Outcome Analysis of Spring Mediated Cranial Reconstruction for the Treatment of Scaphocephaly

Claire Sanger, DO, Stephen S. Glazier, MD, Louis C. Argenta, MD, and Lisa R. David, MD.

Scaphocephaly, the premature fusion of the sagittal suture, is the most common type of craniosynostosis presenting to craniofacial centers across the world. Treatment modalities used for the correction of this deformity run the spectrum of minimally invasive, i.e. Strip craniectomies, to total calvarial vault remodeling. The more aggressive treatment modalities became the gold standard because the long term outcome of the minimally invasive procedures had been suboptimal. We report a 4 year follow up and outcome analysis of spring mediated reconstruction used for the treatment of Scaphocephaly at Wake Forest University since 2001.

The IRB approved prospective study population consisted of children between 3 and 9 months of age with both a clinical and radiographic diagnosis of scaphocephaly. All study patients had 2 memory metal stainless steel springs placed at the time of sagittal strip craniectomy. The children were followed clinically and radiographically from the preoperative diagnosis period through the spring removal period which was done at the time of reossification of the bony calvarial gap. On going patients follow up was done clinically as well as with three dimensional computerized cranial scanning.

Thirty-six (25 males, 11 females) have completed this study in the last 4 years. The mean age at spring placement was 3.7 months and the mean age at spring removal was 8.1 months. The mean bony gap at strip craniectomy was 1.1 cm and after the initial placement was 1.7 cm. The spring design used had a mean footplate gap of 6.8 cm and a mean force at placement of 6.4 Newton. The mean footplate gap at spring removal was 5.8 cm. There were no cases of perioperative mortality and one case where a spring was dislodged after a fall which required reoperation. None of the children required any blood transfusions or prolonged hospitalization i.e. greater than 2 days. The mean preoperative cephalic index was 65 and the mean postoperative cephalic index was 75. Three dimensional computerized scanning corroborates the improvement seen in the cephalic index.

The use of internal cranial springs in conjunction with sagittal strip craniectomy has been shown to be both safe and effective for the treatment of Scaphocephaly with a long term follow up of 4 years. Additional follow up is ongoing as to the development and cranial growth of these children. Our study results to date confirm this as a viable minimally invasive option for the treatment of scaphocephaly.

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