Spring-mediated cranioplasty versus endoscopic strip craniectomy for sagittal craniosynostosis
Open accessAbstract
OBJECTIVE: Endoscopic strip craniectomy (ESC) and spring-mediated cranioplasty (SMC) are two minimally invasive techniques for treating sagittal craniosynostosis in early infancy. Data comparing the perioperative outcomes of these two techniques are sparse. Here, the authors hypothesized that outcomes would be similar between patients undergoing SMC and those undergoing ESC and conducted a study using the multicenter Pediatric Craniofacial Surgery Perioperative Registry (PCSPR). METHODS: The PCSPR was queried for infants under the age of 6 months who had undergone SMC or ESC for sagittal synostosis. SMC patients were propensity score matched 1:2 with ESC patients on age and weight. Primary outcomes were transfusion-free hospital course, intensive care unit (ICU) admission, ICU length of stay (LOS), and hospital length of stay (HLOS). The authors also obtained data points regarding spring removal. Comparisons of outcomes between matched groups were performed with multivariable regression models. RESULTS: The query returned data from 676 infants who had undergone procedures from June 2012 through September 2019, comprising 580 ESC infants from 32 centers and 96 SMC infants from 5 centers. Ninety-six SMC patients were matched to 192 ESC patients. There was no difference in transfusion-free hospital course between the two groups (adjusted odds ratio [aOR] 0.78, 95% CI 0.45–1.35). SMC patients were more likely to be admitted to the ICU (aOR 7.50, 95% CI 3.75–14.99) and had longer ICU LOSs (incident rate ratio [IRR] 1.42, 95% CI 1.37–1.48) and HLOSs (IRR 1.28, 95% CI 1.17–1.39). CONCLUSIONS: In this multicenter study of ESC and SMC, the authors found similar transfusion-free hospital courses; however, SMC infants had longer ICU LOSs and HLOSs. A trial comparing longer-term outcomes in SMC versus ESC would further define the roles of these two approaches in the management of sagittal craniosynostosis.
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Lang et al. (2021) found that the likelihood of ICU admission, length of stay, and overall hospitalisation duration was greater in the spring-assisted surgery group.
“However, the likelihood of being admitted to the intensive care unit, as well as the length of stay and the overall hospitalisation duration, was greater in the spring-assisted surgery group, potentially due to the hospital's protocol [61].”
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 [61]
Lang et al. (2021) found no significant difference in the incidence of a transfusion-free hospital course between ESC and SMC.
“The results indicated no significant difference in the incidence of a transfusion-free hospital course between the two groups.”
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 [61]
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 [61]
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 [61]
Spring-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 [61]
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 [61]
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- Authors
- Lang, S.-S., Meier, P. M., Paden, W. Z., Storm, P. B., Heuer, G. G., Bartlett, S. P., Taylor, J. A., Swanson, J. W., Meara, J. G., Proctor, M., Okunowo, O., Stricker, P. A., & _, _.
- Affiliations
- Children's Hospital of Philadelphia (US)
- Boston Children's Hospital (US)
- Drexel University (US)
- Plastic Surgery Hospital (CN)
- ORCID
- Venue
- Journal of Neurosurgery: Pediatrics
- Published
- 2021-10
- Volume
- 28
- Issue
- 4
- Pages
- 416-424
- ISSN
- 1933-0707 (ISSN-L)
- 1933-0715
- OpenAlex
- W3184543709
- Cited by
- 19
- References
- 37
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 2 · 2023: 2 · 2022: 5
- FWCI
- 1.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurosurgery Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Case Western Reserve University
- Inyuvesi Yakwazulu-Natali
- School of Medicine, University of North Carolina at Chapel Hill
- 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, endoscopic strip craniectomy, infants, perioperative outcomes, intensive care unit admission, ICU length of stay, length of hospital stay
- MeSH terms
- Age Factors, Blood Transfusion, Body Weight, Craniosynostoses, Craniotomy, Critical Care, Endoscopy, Female, Humans, Infant, Length of Stay, Male, Postoperative Complications, Registries, Retrospective Studies, Treatment Outcome, Neurosurgical Procedures, Propensity Score
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