Spring-Assisted Remodeling for Ventricular Shunt-Induced Cranial Deformity

Abstract

Ventricular shunt overdrainage may cause cranial vault collapse, deformation, and secondary craniosynostosis. There is a paucity of information in the literature about this condition or successful low morbidity methods to reshape the cranial vault. Spring-assisted cranioplasty was developed in the Göthenborg Craniofacial Unit and is part of our routine protocol for the treatment of selected patients with craniosynostosis. The same treatment principles were applied to skull deformity secondary to ventricular shunt-associated deformity. Four patients with scaphocephaly secondary to ventricular shunting were treated using expansile springs. Three patients had a secondary sagittal synostosis requiring osteotomy. A further patients' sagittal suture was still patent, and this was expanded without osteotomy. Near normalization of the cranial index and significant aesthetic improvement of the cranial vault were noted in all cases. The mean preoperative cranial index increased from 0.60 to 0.71 within 4 months after surgery. The limited dissection and short operative time enabled minimal morbidity and blood loss compared with that expected with traditional craniofacial reshaping techniques. Patients with ventricular shunt-associated cranial deformity often have associated medical problems. Cranial bone is often in short supply and its quality less than optimal. In this situation, spring-assisted surgery is straightforward and offers significant advantages over traditional craniofacial reshaping techniques.