Spring Cranioplasty for the Fused Sagittal Suture

Abstract Sagittal craniosynostosis is the most common non-syndromic single-suture synostosis, resulting in a restricted, elongated calvarial vault clinically known as scaphocephaly. If left untreated, this mechanical restriction can lead to elevated intracranial pressure and subsequent neurocognitive impairment. Spring-assisted cranioplasty (SAC) has emerged as a safe, minimally invasive surgical alternative to traditional open calvarial vault remodeling (CVR) and endoscopic strip craniectomy (ESC). This procedure combines a targeted osteotomy with the continuous outward distraction of internal metal springs to expand the intracranial space and normalize cranial morphology. SAC is best performed in infants before 6 months, with the springs typically removed 3 to 4 months postimplantation once complete calvarial reossification is radiographically confirmed. Clinical outcomes demonstrate that SAC achieves lasting improvements in the cephalic index comparable to CVR, while significantly reducing intraoperative blood loss, operative duration, intensive care unit utilization, and overall hospital costs. Furthermore, SAC eliminates the extensive, months-long orthotic helmet compliance mandated by ESC, establishing it as a highly effective intervention for appropriately selected infants.