Spring-Assisted Cranioplasty for the Correction of Nonsyndromic Scaphocephaly: A Quantitative Analysis of 100 Consecutive Cases
Abstract
Background: Spring-assisted cranioplasty has been proposed as an alternative to total calvarial remodeling for sagittal craniosynostosis. Advantages include its minimally invasive nature, and reduced morbidity and hospital stay. Potential drawbacks include the need for a second procedure for removal and the lack of published long-term follow-up. The authors present a single-institution experience of 100 consecutive cases using a novel spring design. Methods: All patients treated at the authors’ institution between April of 2010 and September of 2014 were evaluated retrospectively. Patients with isolated nonsyndromic sagittal craniosynostosis were included. Data were collected for operative time, anesthetic time, hospital stay, transfusion requirement, and complications in addition to cephalic index preoperatively and at 1 day, 3 weeks, and 6 months postoperatively. Results: One hundred patients were included. Mean cephalic index was 68 preoperatively, 71 at day 1, and 72 at 3 weeks and 6 months postoperatively. Nine patients required transfusion. Two patients developed a cerebrospinal fluid leak requiring intervention. One patient required early removal of springs because of infection. One patient had a wound dehiscence over the spring and one patient sustained a venous infarct with hemiplegia. Five patients required further calvarial remodeling surgery. Conclusions: The authors’ modified spring design and protocol represents an effective strategy in the management of single-suture sagittal craniosynostosis with reduced total operative time and blood loss compared with alternative treatment strategies. In patients referred within the first 6 months of birth, this technique has become the authors’ procedure of choice. In a minority of cases, especially in the older age groups, further remodeling surgery is required. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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Rodgers et al. confirmed positive outcomes for SMC in 100 consecutive cases of nonsyndromic scaphocephaly.
“Rodgers et al. analysed 100 consecutive cases of nonsyndromic scaphocephaly treated with SMC and confirmed positive outcomes, reinforcing its role as a viable alternative to ESC [63].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [63]
Spring-assisted cranioplasty carries a risk of complications, including cerebrospinal fluid leaks and reoperations, in a cohort of 100 cases.
“In contrast, Rodgers et al. reported that while the technique yielded modest CI improvement, it required a secondary procedure for spring removal [61, 74, 75] and carried a risk of complications, including cerebrospinal fluid leaks and reoperations, in a cohort of 100 cases [63].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [63]
Spring-assisted cranioplasty yields modest cranial index (CI) improvement.
“In contrast, Rodgers et al. reported that while the technique yielded modest CI improvement, it required a secondary procedure for spring removal [61, 74, 75] and carried a risk of complications, including cerebrospinal fluid leaks and reoperations, in a cohort of 100 cases [63].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [63]
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Self-citationManagement of Sagittal and Lambdoid Craniosynostosis
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“24,39 Furthermore, as described by Rodgers et al, 44 the deformity associated with sagittal synostosis is more complex than a simple mismatch in anteroposterior length and biparietal width and also includes frontal bossing, temporal bone invagination, vertex anterior displacement, and occipital prominence.”
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InfluentialSelf-citationSpring-assisted cranioplasty for isolated sagittal craniosynostosis: a retrospective review
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“Similarly, Rodgers et al. analysed 100 consecutive cases of nonsyndromic scaphocephaly treated with SMC and confirmed positive outcomes, reinforcing its role as a viable alternative to ESC [63].”
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Clinical Features and the Use of Three-Dimensional Imaging for Unilateral Lambdoid Synostosis
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“Spring cranioplasty has advantages of a minimally invasive tool that increases volume and circumference with minimal blood loss and shorter hospital stay, but requires a second operation.(31) Our mean operative age for ULS was 14 months (range: 10–20 months).”
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MethodSelf-citationSpring-assisted cranioplasty for children with craniosynostosis
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Virtual Surgical Planning in Craniofacial Surgery
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“Average population skin thickness ( 𝑡 𝑠𝑘𝑖𝑛 ) was calculated.”
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“The initial surgical procedures were performed between April 2010 and September 2015, corresponding to the cohort previously reported for perioperative and mid-term outcomes [12].”
Self-citationSpring cranioplasty for craniosynostosis
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Spring-Assisted Distraction: Principles and Techniques
Jeelani, O. (2018) · Springer eBooks · doi:10.1007/978-3-319-31512-6_73-1 · Cited by 1 · see citing works
Smith, L. G. F., Shah, V., Duenas, H., Onwuka, A. J., Graver, A. E., Governale, L. S., Pearson, G. D. N., & Drapeau, A. I. (2021) · Pediatric Neurosurgery · doi:10.1159/000517118 · Cited by 1 · see citing works
Spring-Assisted Distraction: Principles and Techniques
Jeelani, O. (2020) · Springer eBooks · doi:10.1007/978-3-319-72168-2_73 · Cited by 1 · see citing works
Heelkunde bij aangeboren misvormingen van het aangezicht
Vercruysse, H. J. (2018) · Bijblijven · doi:10.1007/s12414-018-0356-9
Kaiser, G. L., & Steffen, C. (2020) · Child s Nervous System · doi:10.1007/s00381-020-04511-y
Use of Ultrasound in the Planning of Spring-Assisted Cranioplasty for Correction of Scaphocephaly
Graziano, F. D., Sanati-Mehrizy, P., Taub, D. M., Ghatan, S., & Taub, P. J. (2020) · FACE · doi:10.1177/2732501620976170
Removal of cranial springs after spring-mediated cranioplasty
Kalmar, C. L., Swanson, J. W., Shakir, S., Tucker, A. M., Kennedy, B. C., Storm, P. B., Heuer, G. G., Bartlett, S. P. P., Taylor, J. A., & Lang, S. (2021) · Neurosurgical Focus Video · doi:10.3171/2021.1.focvid20102
Intracranial Pressure Management and Posterior Vault Distraction
Arnaud, É., D, G. P. M., Khonsari, R. H., & Haber, S. E. (2023) · Springer eBooks · doi:10.1007/978-3-031-07574-2_2
The Annual ASCFS Whitaker Lecture: Breaking Through to Bold
Driscoll, C. R., & David, L. R. (2023) · FACE · doi:10.1177/27325016231170512
Influence of immunodeficiency on spring-assisted cranioplasty: A study in mice
Cheng, W., Tang, X., Feng, S., Zhang, Z., & Liu, W. (2024) · Current Problems in Surgery · doi:10.1016/j.cpsurg.2024.101508
Mejia, R. F., Rodríguez-Rubio, H. A., Arce-Lozoya, M. A., Chavarría-Mejía, S. R., Hernández-González, F., Martín-García, O. M. S., Serrano-Pinto, Y. G., & Ferrufino-Mejia, A. (2024) · Cureus · doi:10.7759/cureus.73089
Anaesthesia for Craniofacial Surgery in Children
de Beer, D. A. H. (2025) · Cambridge University Press eBooks · doi:10.1017/9781108955409.026
RECONSTRUÇÃO CRANIANA EM CRANIOESTENOSES: 10 ANOS DE EXPERIÊNCIA NO HIJG
Silva, L. R., Moré, M. B., Kondageski, C., de Vasconcellos, J. J. A., & de Vasconcellos, Z. A. A. (2022) · Arquivos Catarinenses de Medicina · doi:10.63845/01b54r87
Multi-Suture Craniosynostosis in Russell-Silver Syndrome: A Rare Clinical Entity
Gomez, D. A., Palmer, S. K., Elkhill, C., Porras, A. R., Abdul-Rahman, O. A., French, B. M., Khechoyan, D. Y., Wilkinson, C., & Nguyen, P. D. (2025) · FACE · doi:10.1177/27325016251357965
“25,26 Although the mean duration of cranial spring placement in the literature ranges from an average of 4.3 to 5.5 months, there is currently no universally accepted duration.”
InfluentialSecondary Synostosis After Spring-Mediated Cranioplasty for Sagittal Synostosis
Shrout, M. A., Watmore, T. D., Jukic, A., & Singh, D. (2025) · The Cleft Palate-Craniofacial Journal · doi:10.1177/10556656251405356
“6,8 In this study, no statistically signi fi cant differences were found in variables such as age, weight, preoperative CI, or spring force between patients who developed UCS and those who did not.”
InfluentialMiller, K., Svientek, S. R., Walsh, L. M., Vercler, C. J., & Magge, S. N. (2026) · FACE · doi:10.1177/27325016261419725
Brulleman, S. I. H. M., Smith, L., Rickart, A., van de Lande, L. S., Jeelani, O., Dunaway, D. J., Schievano, S., Foti, S., & Ong, J. (2026) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000007583
“13,45 For example, correlation with expert assessment Fig.”
Self-citationAquino, V., Arias, A., Morales, C., Yates, D. M., & Makoshi, Z. (2026) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2026.03.020
Postoperative raised ICP after minimally invasive surgery for monosutural craniosynostosis
Martinelli, R., Cusumano, M., Tamburrini, G., & Massimi, L. (2026) · Child s Nervous System · doi:10.1007/s00381-026-07289-7
Fussell, R., & Davies, R. (2026) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000012925
Spring-mediated cranioplasty for scaphocephaly: techniques and outcomes
Guyler, M. R., Perrault, D. P., Naidu, K., Lopez-Becerra, S., Swanson, J. W., Bartlett, S. P. P., Taylor, J. A., & Shakir, S. (2026) · Child s Nervous System · doi:10.1007/s00381-026-07300-1
Spring Cranioplasty for the Fused Sagittal Suture
He, L. R., Pham, K. T., Griffin, S. P., Hoffpauir, L. A., Lee, Y. E., Abu‐Ghname, A., & Khansa, I. (2026) · Seminars in Plastic Surgery · doi:10.1055/a-2927-8854
- Authors
- Rodgers, W., Glass, G. E., Schievano, S., Borghi, A., Rodriguez-Florez, N., Tahim, A., Angullia, F., Breakey, W., Knoops, P., Tenhagen, M., O’Hara, J., Ponniah, A., James, G., Dunaway, D. J., & Jeelani, N. U. O.
- Affiliations
- Great Ormond Street Hospital (GB)
- ORCID
- Venue
- Plastic & Reconstructive Surgery
- Published
- 2017-07
- Volume
- 140
- Issue
- 1
- Pages
- 125-134
- ISSN
- 0032-1052 (ISSN-L)
- OpenAlex
- W2598773808
- Cited by
- 75
- References
- 20
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 7 · 2023: 5 · 2022: 6 · 2021: 8 · 2020: 13 · 2019: 4 · 2018: 7 · 2017: 3
- FWCI
- 4.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Plastic & Reconstructive Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Engineering and Physical Sciences Research Council (EP/N02124X/1)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Keywords
- sagittal craniosynostosis, spring design, cephalic index, postoperative complications, cerebrospinal fluid leak, intraoperative blood loss, operative time
- MeSH terms
- Craniosynostoses, Equipment Design, Female, Humans, Infant, Infant, Newborn, Male, Postoperative Complications, Retrospective Studies, Skull, Plastic Surgery Procedures
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