Spring-assisted cranioplasty for sagittal synostosis: long-term clinical and patient-reported outcomes

PURPOSE: Spring-assisted cranioplasty is an established technique for the correction of isolated sagittal craniosynostosis, yet data on long-term clinical durability and patient-perceived outcomes remain limited. The purpose of this study was to evaluate long-term surgical, aesthetic, and patient-reported outcomes following spring-assisted cranioplasty, with a particular focus on the need for secondary cranial surgery and concordance between surgeon- and parent-reported assessments. METHODS: A single-centre cohort study was performed, including consecutive patients with isolated, nonsyndromic sagittal synostosis treated with spring-assisted cranioplasty between April 2010 and September 2015. Patients were followed within a standardized multidisciplinary craniofacial pathway extending into late childhood and adolescence. Long-term outcomes were assessed using reoperation rates, Kaplan-Meier reoperation-free survival analysis, surgeon-reported Whitaker classification, and structured parent-reported satisfaction measures. RESULTS: Ninety-one of the original 100 patients had complete long-term follow-up and were included, with a mean follow-up duration of 10.0 years (range 5-15 years). Nine patients (9.9%) required secondary cranial surgery during follow-up, including four for raised intracranial pressure and five for aesthetic indications. Reoperation-free survival was 90.1% at 10 years, with the median survival not reached. Surgeon-reported outcomes were excellent, with 87.9% classified as Whitaker Class I. Parent-reported satisfaction was high, with 82.4% completely satisfied and unwilling to consider further surgery. CONCLUSION: Spring-assisted cranioplasty for isolated sagittal synostosis provides durable long-term functional and aesthetic outcomes, with a low incidence of secondary cranial surgery and high patient and parent satisfaction when combined with structured multidisciplinary follow-up.