Understanding the influence of surgical parameters on craniofacial surgery outcomes: a computational study
Open accessAbstract
Sagittal craniosynostosis (SC) is a congenital condition whereby the newborn skull develops abnormally owing to the premature ossification of the sagittal suture. Spring-assisted cranioplasty (SAC) is a minimally invasive surgical technique to treat SC, where metallic distractors are used to reshape the newborn’s head. Although safe and effective, SAC outcomes remain uncertain owing to the limited understanding of skull−distractor interaction and the limited information provided by the analysis of single surgical cases. In this work, an SC population-averaged skull model was created and used to simulate spring insertion by means of the finite-element analysis using a previously developed modelling framework. Surgical parameters were varied to assess the effect of osteotomy and spring positioning, as well as distractor combinations, on the final skull dimensions. Simulation trends were compared with retrospective measurements from clinical imaging (X-ray and three-dimensional photogrammetry scans). It was found that the on-table post-implantation head shape change is more sensitive to spring stiffness than to the other surgical parameters. However, the overall end-of-treatment head shape is more sensitive to spring positioning and osteotomy size parameters. The results of this work suggest that SAC surgical planning should be performed in view of long-term results, rather than immediate on-table reshaping outcomes.
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Spring-mediated cranioplasty (SMC) compared with strip craniectomy (SC) showed comparable transfusion-free hospital courses.
“The results of SMC compared with SC showed comparable transfusion-free hospital courses, but a longer hospitalisation period was observed.”
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 [75]
The Introduction (page unavailable) says spring-assisted cranioplasty has lower blood-transfusion rates than endoscopic strip craniectomy, contrary to the claimed comparable transfusion-free courses. It also reports shorter postoperative intensive-care stays, but does not establish whether total hospitalisation is longer. (LLM, conf=0.78)
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Experimental — accuracy not yet measuredSpring-assisted cranioplasty requires a secondary procedure for spring removal.
“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 [75]
Springs must be removed in a separate procedure once the treatment goal has been achieved.
“In addition, they must be removed in a separate procedure once the treatment goal has been achieved [61, 74, 75].”
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 [75]
SMC compared with SC showed a longer hospitalisation period.
“The results of SMC compared with SC showed comparable transfusion-free hospital courses, but a longer hospitalisation period was observed.”
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 [75]
The Introduction mentions lower blood-transfusion rates and shorter postoperative intensive-care stays for spring-assisted cranioplasty, but does not report a longer hospitalisation period for SMC compared with SC. The Methodology and Results examine cranial shape and surgical parameters; a search for hospital length of stay found no passage addressing the claimed comparison. Page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- He, K. H., Bruse, J. L., Rodriguez-Florez, N., Dunaway, D., Jeelani, O., Schievano, S., & Borghi, A.
- Affiliations
- Ningbo University (CN)
- Vicomtech (ES)
- Universidad de Navarra, TECNUN Escuela de Ingenieros , San Sebastian, Spain
- Great Ormond Street Hospital (GB)
- Durham University (GB)
- Corresponding author
- Borghi, A.
- Venue
- Royal Society Open Science
- Publisher
- The Royal Society
- Published
- 2024-04
- Volume
- 11
- Issue
- 4
- Pages
- 231158-231158
- ISSN
- 2054-5703 (ISSN-L)
- PMC
- PMC10987985
- OpenAlex
- W4393854464
- Cited by
- 6
- References
- 42
- Citations by year
- 2026: 3 · 2025: 3
- FWCI
- 1.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Royal Society Open Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Durham Research Online (Durham University) (publishedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- European Research Council (757923, ERC-2017-StG)
- Great Ormond Street Hospital for Children (12SG15, 17DD46)
- Biomedical Research Centre (17Ds18)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
- Keywords
- sagittal craniosynostosis, spring stiffness, surgical planning, finite element analysis
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