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Spring-Assisted Cranioplasty for Bicoronal Synostosis

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

Journal of Craniofacial Surgery: July 2012 - Volume 23 - Issue 4 - p 977–981
doi: 10.1097/SCS.0b013e31824e2bec
Original Articles

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.

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From the *Craniofacial Unit, Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; and †Department of Pediatric Dentistry and Clinical Genetics, Faculty of Health Sciences, University of Copenhagen; and ‡Department of Clinical Genetics, Copenhagen University Hospital, Copenhagen, Denmark.

Received November 4, 2011.

Accepted for publication January 4, 2012.

Address correspondence and reprint requests to Dr Peter Tarnow, Craniofacial Unit, Department of Plastic Surgery, Sahlgrenska University Hospital, SE- 413 45 Gothenburg, Sweden; E-mail:

This study was supported by grants from Anna and Edwin Bergers Foundation and Wilhelm and Martina Lundgrens Scientific Foundation.

The authors report no conflicts of interest.

© 2012 Mutaz B. Habal, MD