Spring-Assisted Cranioplasty in Multisuture Craniosynostosis: Initial Experience From Thailand

Spring-assisted cranioplasty is a minimally invasive, dynamic technique for cranial expansion in craniosynostosis. This report describes its initial application in Thailand for posterior vault expansion in multisuture cases. Two patients were treated: a 14-month-old boy with secondary multisuture synostosis from a ventriculoperitoneal shunt and an 11-month-old girl with Pfeiffer syndrome. Custom springs were fabricated in-house from 316 stainless steel Kirschner wire, with forces ranging from 2.68 to 4.77 N. A 1-cm wide parieto-occipital strip craniectomy was performed, and 4 springs were placed per patient. Substantial cranial expansion was achieved. The boy's cephalic index improved from 1.29 preoperatively to 1.05 at 1 year, and the girl's normalized from 1.07 to 0.91. Operative times were 100 and 190 minutes, with blood losses of 100 mL and 20 mL, respectively. Springs were removed at 7 and 10 months postoperatively without bony encasement. The first case required ventriculoperitoneal shunt revision for hydrocephalus, highlighting a key consideration in secondary synostosis. Both children showed appropriate developmental progress at follow-up. This initial experience suggests that spring-assisted cranioplasty is a feasible, cost-effective option for posterior vault expansion in complex multisuture craniosynostosis. It provides the benefits of an internal device, reduced operative time and blood loss, and effective cranial reshaping. Careful patient selection is essential, especially for shunt-dependent cases. The technique offers a valuable surgical option in resource-limited settings.