S7A-07 SESSION 7A: SAGITTAL SYNOSTOSIS AN UPDATE ON THE OUTCOMES OF SPRING-ASSISTED SURGERY FOR SAGITTAL CRANIOSYNOSTOSIS

Abstract

Introduction: Spring-assisted surgery (SAS) is an efficacious means for correcting scaphocephaly due to sagittal craniosynostosis. Early intervention for sagittal craniosynostosis using spring-assisted surgery (SAS) is an alternative to calvarial vault remodeling. SAS is performed for patients younger than 6 months of age, and it requires two operations: one for spring placement and a second for spring removal. The long-term safety and efficacy of this technique continue to be reviewed as this technique gains greater acceptance. The nuances of optimizing outcome will also be reviewed. Methods: We performed a retrospective examination of the electronic medical record for all patients treated with SAS for isolated sagittal synostosis at our institution with at least 1 year of follow up (N=179). Cephalic index (CI) was calculated from CT scans, laser Doppler scans, and 3DMD stereophotogammetry. Perioperative data was collected on OR time, blood loss, transfusion rates, and hospital stay, and complications were also collected. Results: There were 179 patients who underwent SAS from 2001 to February 2018. The mean gestationally-corrected age at spring placement and spring removal were 4.4 months and 9.4 months, respectively. Operative time for spring placement was 44.9 minutes, and for spring removal was 26.8 minutes. The mean hospital length of stay for spring placement was 35 hours, and for spring removal was 7.6 hours. One patient required a blood transfusion for the initial placement operation and none for the removal procedure. Mean CI prior to SAS was 70. This improved to 75 after spring placement (p<0.001) and was 74.0 at 1 year after spring placement. This has been maintained with a mean of 75.7 at 12 years post op. Major complications, defined as those requiring a return to the operating room to address spring malposition, exposure, or infection, occurred at a rate of 6.1% with the majority of these occurring during the initial learning curve of the procedure. Conclusion: SAS for isolated craniosynostosis continues to have consistent correction of CI that is maintained over time and a favorable complication profile, as shown by this updated analysis. Outcomes are optimized by earlier placement, accurate positioning in relation to the coronal and lambdoid sutures, and accurate force selection based on type of scaphocephaly and patient profile. The spring removal procedure can be done safely as an outpatient. Finally, after the initial learning curve, the endoscopic approach mirrors the outcomes of the open spring placement.