Implementation of Spring Assisted Cranioplasty at a Single Institution

Spring-assisted cranioplasty (SAC) is a minimally invasive surgical technique for the treatment of craniosynostosis that may reduce operative morbidity compared with traditional open cranial vault remodeling procedures. A retrospective review was conducted of all patients who underwent SAC between May 2019 and August 2024 at a single academic institution serving a socioeconomically vulnerable population. Demographic, clinical, and operative variables were collected, including suture involvement, spring configuration, perioperative outcomes, complications, and need for secondary procedures. A total of 43 patients met the inclusion criteria, of whom 84% had single-suture craniosynostosis, most commonly sagittal synostosis (78%). The mean age at surgery was 3.79±0.37 months. Springs remained in place for an average of 89.00±9.59 days with a mean total exertional force of 26.26±2.12 N. No intraoperative complications occurred. Four patients (9.3%) experienced postoperative complications, including hematoma or seroma formation and wound infection, with 1 patient (2.3%) requiring hospitalization for postoperative infection following spring removal. No cases of spring migration or hardware failure were observed. Five patients (11.6%) required additional cranial procedures and were more likely to be female, syndromic, and have multisuture or coronal craniosynostosis. The mean length of stay following spring insertion was 2.81±0.19 days. These findings support the feasibility of implementing SAC in a high-social-vulnerability patient population and demonstrate favorable early outcomes following adoption of this minimally invasive approach for craniosynostosis management.