Purpose: Spring-assisted cranioplasty is an alternative surgical option for patients with sagittal craniosynostosis practiced at our centre since 2009. The technique has been described as being less invasive with reduced morbidity compared to total calvarial remodelling but requires a second procedure for spring removal. We hope to present our centre’s experience with this technique over the last 10 years.
Methods: Clinical notes of all patients with sagittal craniosynostosis treated by our craniofacial team between 2009 and 2019 was reviewed for complication rates, operative time, transfusion requirement, and cephalic index difference. Outcomes of the first five years of practice were then compared to the latter five.
Results: 32 patients included with mean follow up of 48 months. No events of dural tears, cerebrospinal fluid leak or increased intracranial pressure. One patient was readmitted for suspected post-operative infection, one for scar revision, and one for early spring removal. Three patients required further revision for inadequate correction and all were in our first five years of practice. Despite this, correction measured by mean cephalic index difference in initial and latter five years was 5.8 vs 7.1 (p<0.00001). Further comparisons of first and latter five years showed improving practice with reduced theatre time for spring insertion 178 vs 130 minutes (p=0.000108), and reduced transfusion requirements with 100% vs 47% of patients requiring blood which could related to the increased use of tranexamic acid from 0% to 59%.
Conclusion: Spring-assisted cranioplasty is a safe technique for sagittal synostosis with a low complication profile. Transfusion requirement remains an ongoing concern despite the less invasive nature of this procedure and tranexamic acid may play a role to reduce this. Over time, our practice continues to improve which may be due to the learning curve, paradigm shift in anaesthetic care, or modifications in operative technique.