Spring treatment for craniosynostosis

The skull bones are made up of ‘plates’ that protect the brain and allow it space to grow. Sometimes, the plates of a baby’s skull fuse too early.

This can lead to an unusual head shape and cause pressure on the brain and problems with development. This early fusion of skull bones is called “craniosynostosis” and it occurs in 1:2000 children.

The most common form of craniosynostosis is where the two bones in the middle of the skull (Figure 1) fuse in the midline – this is called “sagittal synostosis”. As a result of this fusion, the baby’s head can’t grow in a “side to side” direction – it can only grow in a “forward and backward” direction. The child ends up with a long and narrow head. This head shape is called “scaphocephaly” (Figure 2).

Traditionally, methods to treat sagittal synostosis involved complex and long operations to remove the skull cap, remodel the bones and reattach the remodelled skull. This operation is called “total calvarial vault remodelling”. Children stayed in hospital for long periods of time and required large blood transfusions during the complex surgery where significant amounts of blood can be lost.

More recently, surgeons have tried to develop less invasive ways of treating fusion of the skull bones. In the 1990s a team of craniofacial surgeons in Sweden developed a technique where small incisions were made on the scalp, the fused bones were divided, and then metal springs were inserted to push the fused bones apart and adjusted to improve the head shape. A few months later during a second smaller operation, the metal springs are then removed. This technique is called “spring assisted cranioplasty” (Figure 3).

Two recent scientific studies, one from the UK and one from the Netherlands, looked at over 180 patients with spring-assisted cranioplasties. Results of these studies show similar outcomes for patients compared to the more invasive remodelling procedures. [1, 2]

They confirm that spring-assisted cranioplasty is less invasive and quicker. The need for a blood transfusion is less likely because there is less bleeding which result in shorter hospital stays.

The disadvantage of spring-assisted cranioplasties is that the children need to have a second minor operation to have the springs removed.

Like all operations, there are risks involved. Potential complications include bleeding, infection and in some cases inadequate correction of the abnormal growth which may require further operation.

Spring-assisted cranioplasty is an effective and safe procedure for sagittal synostosis. It is less invasive and therefore the infant loses less blood and stays in hospital for a shorter amount of time.

The research referenced in this article comes from these two studies.

  1. Rodgers, W., et al., Spring-Assisted Cranioplasty for the Correction of Nonsyndromic Scaphocephaly: A Quantitative Analysis of 100 Consecutive Cases. Plast Reconstr Surg, 2017. 140(1): p. 125-134.
  2. van Veelen, M.C., et al., Minimally Invasive, Spring-Assisted Correction of Sagittal Suture Synostosis: Technique, Outcome, and Complications in 83 Cases. Plast Reconstr Surg, 2018. 141(2): p. 423-433.

Dr Derek Liang and A/Prof Damian Marucci - SCHN Craniofacial team