Journal of Craniofacial Surgery

Skip Navigation LinksHome > July 2012 - Volume 23 - Issue 4 > Spring-Assisted Cranioplasty for Bicoronal Synostosis
Journal of Craniofacial Surgery:
doi: 10.1097/SCS.0b013e31824e2bec
Original Articles

Spring-Assisted Cranioplasty for Bicoronal Synostosis

Tovetjärn, Robert MD*; Maltese, Giovanni MD*; Kölby, Lars MD, PhD*; Kreiborg, Sven DDS, PhD†‡; Tarnow, Peter MD, PhD*

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Background: Numerous surgical techniques for cranial reconstruction of patients with bicoronal synostosis have been suggested. The outcome is, however, still often suboptimal.

Methods: Since 2005, we have, at the Craniofacial Unit, Sahlgrenska University Hospital, Gothenburg, used a standardized surgical technique with advancement and remodeling of the forehead combined with spring distraction of the occipital area. The aim of the current study was to evaluate this operative technique. Eighteen consecutive patients (9 boys and 9 girls) with bicoronal synostosis operated on using this technique were identified. Sixteen patients had syndromic bicoronal synostosis, and 2 had nonsyndromic bicoronal synostosis. Cephalic index was obtained from three-dimensional computed tomography scans, and photographs were analyzed for aesthetic evaluation.

Results: The preoperative calvarial shape was hyperbrachycephalic in all subjects. Postoperatively, the calvarial shape was, in general, much closer to the norm. The reduction in the mean cephalic index from the preoperative stage (94) to the 3-year follow-up (82) was statistically significant (P < 0.0001). The mean duration of surgery was 155 (SD, 32) minutes, with a mean perioperative bleeding of 237 (SD, 95) mL. The mean hospital stay was 6.3 (SD, 1.5) days, of which the mean intensive care unit stay was 1.6 (SD, 1.2) days. In 2 patients, one of the springs had to be reinserted because of postoperative dislocation. No other major complications were observed.

Conclusions: Spring-assisted cranioplasty for bicoronal synostosis is a safe technique, is less invasive than many other cranioplasties, and results in marked improvement in the calvarial shape.

© 2012 Mutaz B. Habal, MD

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