Skip to main content
SpringerLink
Log in

Adaptation of the cranium to spring cranioplasty forces

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Background

During spring-assisted cranioplasty, the spring transmits forces through adjacent cranium. We have previously demonstrated that the ectocranial–endocranial thickness of cranial sutures increases significantly over time in the presence of continuous spring forces. We wished to investigate if cranial bone showed similar adaptational responses.

Methods

New Zealand white rabbits were randomized into a treatment group [a spring was placed across a posterior frontal suture (PFS) suturectomy and a control group (PFS suturectomy)]. Animals (n = 6) were euthanized from each group at 4, 7, and 10 weeks, respectively. A sham group (n = 6) was euthanized at 10 weeks. Frontal bone thickness was recorded at five reproducible anatomical points on the frontal bone. Histological analysis of the bone architecture was performed.

Results

Frontal bone thickness was significantly greater than controls at all five sites at weeks 7 and 10. There were multiple significant differences between the 4-, 7-, and 10-week groups with each site progressively thickening over time. Histological analysis revealed a uniform increase in thickness of the endocranial and ectocranial cortical bone in the treatment groups.

Conclusions

Cranial bone adapts to the presence of continuous spring cranioplasty forces by progressively thickening over time. This property is beneficial in craniosynostosis cases with very thin and poor quality bone and may partly explain the observed lack of spring erosion through bone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Lauritzen C, Davis C, Ivarsson A, Hewitt T (2008) The evolving role of springs in craniofacial surgery: the first 100 clinical cases. Plast Reconstr Surg 121:545–554

    Article  CAS  PubMed  Google Scholar 

  2. Guimaraes-Ferreira J, Gewalli G, David L, Olsson R, Friede H, Lauritzen C (2003) Spring mediated cranioplasty compared with the modified pi-plasty for sagittal synostosis. Scand J Plast Reconstr Surg Hand Surg 37:208–215

    Article  PubMed  Google Scholar 

  3. Windh P, Davis C, Sanger C, Sahlin P, Lauritzen (2008) Spring-assisted cranioplasty vs pi-plasty for sagittal synostosis—a long-term follow-up study. J Craniofac Surg 19:59–64

    PubMed  Google Scholar 

  4. Mackenzie K, Davis C, Yang A, MacFarlane M (2009) Evolution of the treatment of sagittal synostosis: the role of new technologies. J Craniofac Surg 20:129–133

    Article  PubMed  Google Scholar 

  5. Davis C, Wickremesekera A, MacFarlane MR (2009) Correction of nonsynostotic scaphocephaly without cranial osteotomy: spring expansion of the sagittal suture. Childs Nerv Syst 25:225–230

    Article  PubMed  Google Scholar 

  6. David LR, Proffer P, Hurst WJ, Glazier S, Argenta LC (2004) Spring-mediated cranial reshaping for craniosynostosis. J Craniofac Surg 15:810–816

    Article  PubMed  Google Scholar 

  7. Davis C, Windh P, Lauritzen C (2009) Spring-assisted cranioplasty alters the growth vectors of adjacent cranial sutures. Plast Reconstr Surg 129:470–474

    Article  Google Scholar 

  8. Coats B, Margulies SS (2006) Material properties of human infant skull and suture at high rates. J Neurotrauma 23:1222–1232

    Article  PubMed  Google Scholar 

  9. Davis C, Lauritzen C (2009) Frontobasal suture distraction corrects hypotelorism in metopic synostosis. J Craniofac Surg 20:121–124

    Article  PubMed  Google Scholar 

  10. Davis C, Windh P, Lauritzen C (2009) Cranial bone and suture strains incident to spring-assisted cranioplasty. Plast Reconstr Surg (in press)

  11. Davis C, Windh P, Lauritzen C (2009) Biomechanical characteristics of cranial sutures are altered by spring cranioplasty forces. Plast Reconstr Surg (in press)

  12. Gewalli F, Guimaraes-Ferreira J, Maltese G, Ortengren U, Lauritzen C (2001) Expander elements in craniofacial surgery: an experimental study in rabbits. Scand J Plast Reconstr Hand Surg 35:149–156

    Article  CAS  Google Scholar 

  13. David LR, Gewalli F, Guimaraes-Ferreira J et al (2002) Dynamic spring-mediated cranioplasty in a rabbit model. J Craniofac Surg 13:794–801

    Article  PubMed  Google Scholar 

  14. Davis C, Windh P, Lauritzen C (2009) Do expansile cranial springs erode through the cranium? J Craniofac Surg 20:168–170

    Article  PubMed  Google Scholar 

  15. Davis C, Lauritzen CG (2008) Spring-assisted remodeling for ventricular shunt-induced cranial deformity. J Craniofac Surg 19:588–592

    Article  PubMed  Google Scholar 

  16. Mao JJ, Nah HD (2004) Growth and development: hereditary and mechanical modulations. Am J Dentofacial Orthop 125:676–689

    Article  Google Scholar 

  17. Raab-Cullen DM, Theide MA, Petersen DN et al (1994) Mechanical loading stimulates rapid changes in periosteal gene expression. Calcif Tissue Int 55:473–478

    Article  CAS  PubMed  Google Scholar 

  18. Harter LV, Hruska KA, Duncan RL (1995) Human osteoblast-like cells respond to mechanical strain with increased bone matrix production independent of hormonal regulation. Endo 136:528–535

    CAS  Google Scholar 

  19. Rubin CT, Lanyon LE (1984) Regulation of bone formation by applied dynamic loads. J Bone Joint Surg 66A:397–402

    Google Scholar 

  20. Frost HM (1996) Perspectives: a proposed general model of the “mechanostat”. Anat Rec 244:139–147

    Article  CAS  PubMed  Google Scholar 

  21. Alexandridis C, Caputo AA, Thanos CE (1985) Distribution of stresses in the human skull. J Oral Rehabil 12:499–507

    Article  CAS  PubMed  Google Scholar 

  22. Witzel U, Preuschoft H (2002) Function-dependent shape characteristics of the human skull. Anthropol Anz 60:113–135

    CAS  PubMed  Google Scholar 

  23. Ross CF (2001) In vivo function of the craniofacial haft: the interorbital pillar. Am J Phys Anthrop 116:108–139

    Article  CAS  PubMed  Google Scholar 

  24. Rafferty KL, Herring SW, Marshall CD (2003) Biomechanics of the rostrum and the role of facial sutures. J Morphol 257:33–44

    Article  PubMed  Google Scholar 

  25. Herring SW, Teng S (2000) Strain in the braincase and its sutures during function. Am J Phys Anthropol 112:575–593

    Article  CAS  PubMed  Google Scholar 

  26. Popwics TE, Herring SW (2007) Load transmission in the nasofrontal suture of the pig, Sus scrofa. J Biomech 40:837–844

    Article  Google Scholar 

  27. Iwasaki K (1989) Dynamic responses in adult and infant monkey craniums during occlusion and mastication. J Osaka Dent Univ 23:77–97

    CAS  PubMed  Google Scholar 

  28. Liebermann DE (1996) How and why humans grow thin skulls: Experimental evidence for systemic cortical robusticity. Am J Phys Anthropol 101:217–236

    Article  Google Scholar 

Download references

Acknowledgments

We are very grateful to Dr. Bronwen Kelly for her expert assistance with the statistical analysis.

Author information

Authors and Affiliations

  1. Central & Southern New Zealand Craniofacial Program, PO Box 45140, Wellington, 5042, New Zealand

    Charles Davis, Per Windh & Claes G. K. Lauritzen

Authors
  1. Charles Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Per Windh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claes G. K. Lauritzen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles Davis.

Additional information

Financial disclosure and products

Charles Davis, Per Windh, and Claes Lauritzen, the authors of this manuscript, have no financial interest in the spring technology or techniques used in this paper.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Davis, C., Windh, P. & Lauritzen, C.G.K. Adaptation of the cranium to spring cranioplasty forces. Childs Nerv Syst 26, 367–371 (2010). https://doi.org/10.1007/s00381-009-1026-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-009-1026-0

Keywords

Search

Navigation