Leptomeningeal Cyst Following Spring-Assisted Cranioplasty for Correction of Sagittal Craniosynostosis: A Case Report and Literature Review

Background: Spring-assisted cranioplasty (SAC) and endoscopic strip craniectomy (ESC) with postoperative helmet therapy are minimally invasive procedures that are increasingly utilized to treat craniosynostosis, largely due to their less invasive nature, compared to open calvarial vault reconstruction (CVR). Enthusiasm for SAC has surged in the absence of reported complications. Case presentation: We present the case of an 11-month-old infant who developed a large leptomeningeal cyst following SAC for sagittal craniosynostosis. Additionally, we conducted a literature review of articles focusing on the complications associated with SAC. Discussion: The patient required subsequent surgical repair and cranial reconstruction, which resulted in a full recovery. The literature review revealed 11 studies describing 571 total operations. Across the studies identified in this review, the most common complications were delays in calvarial ossification, undercorrection, perioperative return, and difficult spring removal. Of these 571 total operations, 3 patients’ postoperative courses were complicated by CSF leak. Conclusions: Though dural injury is a rarely reported complication of SAC, surgeons should be cautious of the spring instrumentation, which can cause significant morbidity if dural injury goes unrecognized and is not properly managed.