Minimally Invasive, Spring-Assisted Correction of Sagittal Suture Synostosis: Technique, Outcome, and Complications in 83 Cases

Veelen, Marie-Lise C. van; Kamst, Nathalie W.; Touw, Carolina E.; Mauff, Katya; Versnel, Sarah L.; Dammers, Rúben; Jong, T. H. R. de; Prasad, Vani; Mathijssen, Irene M J

doi:10.1097/prs.0000000000004037

Cited by 41 publications

(29 citation statements)

References 48 publications

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“…Three patients in the springs group had displacement of their spring distractors and were placed in a helmet after removal of the springs earlier than planned. Our series reports an incidence of spring dislodgement similar to prior studies [34, 35], while others have none [10, 36, 37]. On the other hand, even with these early failures, SMSR had a lower rate of conversion to open CVR compared to SCH.…”

Section: Discussionsupporting

confidence: 86%

Comparison of Perioperative Outcomes and Parental Satisfaction Outcomes of Strip Craniectomy with Postoperative Helmet versus Spring-Mediated Remodeling in Sagittal Craniosynostosis

et al. 2021

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Introduction: We sought to compare outcomes and parental satisfaction between 2 approaches for sagittal craniosynostosis: strip craniectomy with spring-mediated skull remodeling (SMSR) and strip craniectomy with postoperative helmet (SCH). Methods: Perioperative and outcome data for SMSR or SCH patients between September 2010 and July 2019 were retrospectively reviewed. A telephone survey was administered to parents of children who underwent both procedures. Results: A total of 62 children were treated for sagittal craniosynostosis by either SMSR (n = 45) or SCH (n = 17). The SCH group had a lower estimated blood loss (27 vs. 47.06 mL, p = 0.021) and age at surgery (13.0 vs. 19.8 weeks) than the SMSR group. Three patients underwent early springs removal due to trauma or dislodgement, all of whom converted to helmeting. Of the 62 children initially identified, 59 were determined to have an adequate follow-up time to assess long-term outcomes. The mean follow-up time was 30.1 months (n = 16) in the SCH group and 32.0 months in the SMSR group (n = 43, p = 0.39). Two patients in the SCH group and one in the SMSR group converted to open cranial vault reconstruction. Thirty parents agreed to respond to the satisfaction survey (8 SCH, 22 SMSR) based on a Likert scale of responses (0 being most dissatisfied possible, 4 most satisfied possible). Average satisfaction was 3.86/4.0 in the SCH group and 3.45/4.0 in the SMSR group. No parents in the SCH group would change to SMSR, while 3 of the 22 SMSR survey responders would have changed to SCH. Conclusions: Perioperative outcomes and average parental satisfaction were similar in both groups. Importance of helmet wear compliance and risk of spring dislodgement should be discussed with parents.

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Section: Discussionsupporting

confidence: 86%

Comparison of Perioperative Outcomes and Parental Satisfaction Outcomes of Strip Craniectomy with Postoperative Helmet versus Spring-Mediated Remodeling in Sagittal Craniosynostosis

et al. 2021

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“…The present model is suitable for the prediction of SAC outcome in patients affected by sagittal craniosynostosis aged between 3 and 8 months (as the subgroup used for material optimization): adoption in different patient cohorts receiving spring cranioplasty for a different indication, such as posterior vault expansion (van Veelen and Mathijssen 2012 ) and correction of metopic (Lauritzen et al 2008 ) and lambdoid (Arnaud et al 2012 ) synostosis, may require a different material model due to the different nature of the pathology—syndromic craniosynostosis for patients affected by Crouzon syndrome and Apert syndromes who receive spring-assisted posterior vault expansion (de Jong et al 2013 )] or different age range (Davis et al 2010 ; van Veelen et al 2017 ): this methodology would still be valid if reproduced in a different patient cohort.…”

Section: Discussionmentioning

confidence: 99%

A population-specific material model for sagittal craniosynostosis to predict surgical shape outcomes

Borghi

Rodríguez-Flórez

Ruggiero

et al. 2019

Biomech Model Mechanobiol

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Sagittal craniosynostosis consists of premature fusion (ossification) of the sagittal suture during infancy, resulting in head deformity and brain growth restriction. Spring-assisted cranioplasty (SAC) entails skull incisions to free the fused suture and insertion of two springs (metallic distractors) to promote cranial reshaping. Although safe and effective, SAC outcomes remain uncertain. We aimed hereby to obtain and validate a skull material model for SAC outcome prediction. Computed tomography data relative to 18 patients were processed to simulate surgical cuts and spring location. A rescaling model for age matching was created using retrospective data and validated. Design of experiments was used to assess the effect of different material property parameters on the model output. Subsequent material optimization-using retrospective clinical spring measurements-was performed for nine patients. A population-derived material model was obtained and applied to the whole population. Results showed that bone Young's modulus and relaxation modulus had the largest effect on the model predictions: the use of the population-derived material model had a negligible effect on improving the prediction of on-table opening while significantly improved the prediction of spring kinematics at follow-up. The model was validated using on-table 3D scans for nine patients: the predicted head shape approximated within 2 mm the 3D scan model in 80% of the surface points, in 8 out of 9 patients. The accuracy and reliability of the developed computational model of SAC were increased using population data: this tool is now ready for prospective clinical application.

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“…While the results of open cranial vault reconstruction have been widely documented (Marsh et al, 1991; Panchal et al, 1999; Heller et al, 2008), the benefits of endoscopic techniques have been elucidated only recently (Jimenez et al, 2002; Berry-Candelario et al, 2011; Ridgway et al, 2011; Shah et al, 2011; Chan et al, 2013; Le et al, 2014; Proctor, 2014; Vogel et al, 2014; Ghenbot et al, 2015; van Veelen et al, 2018). One frequently cited technique in the endoscopic correction of sagittal craniosynostosis is craniectomy with postoperative molding helmet therapy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 2 Sagittal Craniosynostosis Repair Techniques: Spring-Assisted Surgery Versus Endoscope-Assisted Craniectomy With Helmet Molding Therapy

Skolnick¹,

Patel³

et al. 2020

The Cleft Palate Craniofacial Journal

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Introduction: This study compares anthropometric outcomes of 2 sagittal synostosis repair techniques: spring-assisted surgery and endoscope-assisted craniectomy with molding helmet therapy. Methods: Patients undergoing spring-assisted surgery (n = 27) or endoscope-assisted craniectomy with helmet therapy (n = 40) at separate institutions were retrospectively reviewed. Pre- and 1-year postoperative computed tomography (CT) or laser scans were analyzed for traditional cranial index (CI), adjusted cranial index (aCI), and cranial vault volume (CVV). Nine patient-matched scans were analyzed for measurement consistency. Results: The spring-assisted group was older at both time points ( P < .050) and spring-assisted group CVV was larger preoperatively and postoperatively ( P < .01). However, the change in CVV did not differ between the groups ( P = .210). There was no difference in preoperative CI (helmet vs spring: 70.1 vs 71.2, P = .368) between the groups. Postoperatively, helmet group CI (77.0 vs 74.3, P = .008) was greater. The helmet group also demonstrated a greater increase in CI (6.9 vs 3.1, P < .001). The proportion of patients achieving CI of 75 or greater was not significantly different between the groups (helmet vs spring: CI, 65% vs 52%, P = .370). There was no detectable bias in CI between matched CT and laser scans. Differences were identified between scan types in aCI and CVV measurements; subsequent analyses used corrected CVV and aCI measures for laser scan measures. Conclusions: Both techniques had equivalent proportions of patients achieving normal CI, comparable effects on cranial volume, and similar operative characteristics. The study suggests that there may be greater improvement in CI in the helmet group. However, further research should be performed.

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Minimally Invasive, Spring-Assisted Correction of Sagittal Suture Synostosis: Technique, Outcome, and Complications in 83 Cases

Abstract: Therapeutic, IV.

Cited by 41 publications

References 48 publications

Comparison of Perioperative Outcomes and Parental Satisfaction Outcomes of Strip Craniectomy with Postoperative Helmet versus Spring-Mediated Remodeling in Sagittal Craniosynostosis

Comparison of Perioperative Outcomes and Parental Satisfaction Outcomes of Strip Craniectomy with Postoperative Helmet versus Spring-Mediated Remodeling in Sagittal Craniosynostosis

A population-specific material model for sagittal craniosynostosis to predict surgical shape outcomes

Comparison of 2 Sagittal Craniosynostosis Repair Techniques: Spring-Assisted Surgery Versus Endoscope-Assisted Craniectomy With Helmet Molding Therapy

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