Abstract
Background
Scaphocephaly is usually due to sagittal synostosis. Scaphocephaly may also be seen in the presence of a nonsynostosed sagittal suture. In this situation traditional surgery is controversial due to the altered risk–benefit profile. This paper reports the first known series of patients with nonsynostotic scaphocephaly treated using spring assisted expansion of the sagittal suture.
Methods
All patients referred to our craniofacial program over the period February 2005–February 2008 were retrospectively reviewed. Eleven patients were seen with nonsynostotic scaphocephaly. Seven patients underwent spring expansion of the sagittal suture without osteotomy.
Results
Four female and three male patients had spring expansion of a patent sagittal suture. Four patients were born prematurely. Two patients had Beckwith–Weidemann syndrome. The ages ranged from 6 to 26 months (mean 12 months). The average preoperative cranial index was 66 (range 63–67). This improved to 76 at the time of spring removal (range 73–78). Springs were kept in situ for an average of 7.25 months. The mean blood loss was 7 ml and the mean operative time 36 min.
Conclusion
Spring cranioplasty for sagittal synostosis is ideally performed before 6 months of age however in nonsynostotic scaphocephaly older children can be considered due to the absence of frontal bossing. Significant aesthetic improvement was achieved in all cases and normalization of the cranial index was achieved in 86% of cases with minimal morbidity and no significant complications. This technique is an alternative for nonsynostotic cases that were previously either untreated or undergone major remodelling surgery.
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Acknowledgements
Charles Davis learned the technique of spring-assisted cranioplasty from Professor Claes Lauritzen during his time as a craniofacial fellow in the Gothenborg Craniofacial unit in 2003/2004. He is very grateful for this experience.
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Financial disclosure and products: the authors of this manuscript have no financial interest in the technology or techniques used in this paper.
Product: stainless steel spring as pioneered by Professor Claes Lauritzens Craniofacial Unit in Gothenborg, Sweden. In our craniofacial program these springs are manufactured in the Department of Medical Physics and Bioengineering at Christchurch Hospital, Christchurch, New Zealand.
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Davis, C., Wickremesekera, A. & MacFarlane, M.R. Correction of nonsynostotic scaphocephaly without cranial osteotomy: spring expansion of the sagittal suture. Childs Nerv Syst 25, 225–230 (2009). https://doi.org/10.1007/s00381-008-0719-0
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DOI: https://doi.org/10.1007/s00381-008-0719-0