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Introduction of Spring-Assisted Cranioplasty for Sagittal Craniosynostosis in a Craniofacial Service: A Report of
Sherif Bakri1, Ahmed S Mazeed1, Samia Saied1
1Department of Plastic Surgery, Cleft and Craniofacial Unit.
Insights
Spring-assisted cranioplasty (SAC) is a safe and minimally invasive technique for treating sagittal craniosynostosis in children. This Egyptian experience shows promising outcomes with reduced hospital stays and minimal complications.
Area of Science:
- Pediatric Surgery
- Craniofacial Surgery
- Neurosurgery
Background:
- Craniosynostosis is a condition where skull sutures fuse prematurely.
- Sagittal synostosis (scaphocephaly) results in an elongated head shape.
- Spring-assisted cranioplasty (SAC) offers dynamic cranial reshaping.
Purpose of the Study:
- To report the initial Egyptian experience with SAC for sagittal synostosis.
- To evaluate the preliminary outcomes and safety of SAC in pediatric patients.
Main Methods:
- Seventeen children with scaphocephaly underwent SAC.
- A midline osteotomy along the sagittal suture was performed, followed by spring insertion.
- Key metrics recorded included operative time, blood transfusion, hospital stay, and complications.
Main Results:
- All 17 patients successfully underwent SAC with no significant complications.
- Mean operative time for spring insertion was 63 minutes; spring removal averaged 22.8 minutes.
- Mean hospital stay was 3.2 days, with 41.2% requiring blood transfusions.
Conclusions:
- SAC is a safe, effective, and minimally invasive treatment for sagittal craniosynostosis.
- The technique demonstrates benefits including limited dural undermining and reduced hospital stay.
- SAC can be readily integrated into craniofacial surgical practices.
Abstract:
Spring-assisted cranioplasty (SAC) for the treatment of craniosynostosis uses internal springs to produce dynamic changes in cranial shape over several months before its removal. The purpose of this study was to report the first Egyptian experiences with SAC in the treatment of children with sagittal synostosis and evaluate the preliminary outcome. A total of 17 consecutive patients with scaphocephaly underwent SAC with a midline osteotomy along the fused sagittal suture and insertion of 3 springs with bayonet-shaped ends across the opened suture. Operative time, blood transfusion requirements and length of ICU, total hospital stay, and complications graded according to Oxford protocol classification were recorded. Spring removal was performed once re-ossification of the cranial defect occurred. All patients successfully underwent SAC without significant complications. The mean age at surgery was 6.8 months. The mean time of the spring insertion surgery was 63 minutes (SD 9.7). Blood transfusion was needed in less than half of the patients (41.2%).The mean duration of hospital stay was 3.2 days. The mean timing of spring removal was 5.5 months (SD 0.4). The mean time of the second surgery (spring removal) was 22.8 minutes (SD 3.6). In conclusion, SAC can easily be incorporated into the treatment armamentarium of craniofacial surgeons. The technique offers a safe and minimally invasive option for the treatment of sagittal craniosynostosis with the benefit of limited dural undermining, minimal blood loss, operative time, anesthetic time, ICU stay, and hospital stay.
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