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Spring-Assisted Surgery in the Treatment of Complex Craniosynostosis

Journal article
Authors Ruggero Bevilacqua
Peter Tarnow
Lars Kölby
Giovanni Maltese
Published in Journal of Craniofacial Surgery
Volume 29
Issue 4
Pages 920-924
ISSN 1049-2275
Publication year 2018
Published at Institute of Clinical Sciences, Department of Plastic Surgery
Pages 920-924
Language en
Links dx.doi.org/10.1097/scs.000000000000...
Keywords Complex synostosis, cranial remodeling, intracranial volume, spring-assisted surgery, long-term, metopic synostosis, follow-up, cranioplasty, growth, hypotelorism, deletions, Surgery
Subject categories Surgery

Abstract

Multisutural nonsyndromic craniosynostosis is a rare group of malformations, whose frequency has been reported between 3% and 7% of all craniosynostosis. The clinical diagnosis can be difficult and computed tomography is usually required. Surgical treatment is challenging and staged procedures are performed in up to 80% of patients. The aim of the present study was to determine the reoperation rate and to evaluate the surgical outcomes by measuring intracranial volume (ICV) preoperatively and at follow-up, and comparing it to a control group. Perioperative variables and reoperation rate were recorded. Fifty-one patients presented with a complex pattern of synostosis without a recognizable syndrome (5% of cases of total patients evaluated). Fifteen patients have been treated with spring-assisted surgery, either alone or in combination with a foreheadplasty. The mean follow-up was 6.2 years. The mean preoperative ICV of the patients was smaller, but not significantly, than in the normal population (P = 0.13). Postoperatively, the mean ICV was similar to that of the control group at 1 year (P = 0.92), while at 3 years it was appreciably smaller, although not significantly different (P = 0.06). Five patients (33%) went through a secondary skull expansion for either raised intracranial pressure or cosmetic reasons. Spring-assisted surgery seems to temporarily expand ICV in children with complex synostosis and lower the reoperation rate, thus reducing the need for a second procedure. A longer follow-up would be necessary to further investigate the effects of springs over time.

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