Download

Download Full Text (714 KB)

Description

Strip craniectomy (SC) is a well-established for the correction of metopic craniosynostosis that relies on postoperative orthotic helmet molding to guide cranial reshaping over time. Spring-assisted cranioplasty (SAC) is a less frequently described treatment that provides active anterior cranial expansion via cranial springs. While SAC is well-described for sagittal craniosynostosis, its application in metopic craniosynostosis is less frequently described and comparative data evaluating postoperative cranial morphology remain limited. This study aims to compare treatment timelines and postoperative cranial shape between SC and SAC using measurements derived from 3D laser scans.

This IRB-approved, retrospective cohort study included pediatric patients who underwent SC or SAC for metopic craniosynostosis between 2021-2024 and completed helmet therapy. 3D laser scan data were collected at helmet initiation and completion. Metrics included anterior cranial volume and anterior-posterior volume ratio (APVR). Normally distributed variables are presented as mean±SD and compared using t-tests; non-normal variables are summarized as median [IQR] and analyzed with Wilcoxon Rank Sum tests.

Ten patients (5 SAC, 5 SC) were included in this study. There was no difference between SAC and SC for age at diagnosis (46.4±45.6 vs 63.4±29.5 days, p=0.5) or age at surgery (134.0±28.2 vs 110.4±10.7 days, p=0.12). For SAC patients, springs remained in place for 80±8.5 days before removal. At helmet initiation, anterior volume in the SAC group was 435.5±66.6 mm3 and 328.4±91.8 mm3 in the SC group (p=0.07). After completion of helmet therapy, anterior volume was 481.1±48.5 vs 414.1±67.2 mm3 (p=0.11) for SAC and SC, respectively. Initial APVR was 0.95 [0.92, 0.97] for SAC and 0.91 [0.90, 0.94] for SC (p=0.3), with final values of 0.961±0.034 and 0.926±0.023, respectively (p=0.09). Helmet therapy duration was significantly shorted in SAC (97.8 ±48.3 vs 187.4 ±54.9 days, p=0.03), with no difference in total time from surgery to helmet therapy completion (199.4 ± 39.3 vs 184.8 ± 52.7, p=0.63).

Within the first year postoperatively, no significant differences were observed in anterior volume or APVR between SAC and SC. There is a trend toward greater anterior volume SAC patients even prior to helmet therapy completion. SAC resulted in significantly shorter helmet therapy duration. These findings suggest that SAC offers at least equivalent morphologic and cranial volume improvement and reduced reliance on prolonged orthotic therapy in metopic craniosynostosis.

Publication Date

5-8-2026

Disciplines

Plastic Surgery

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2036

Spring Assisted Cranioplasty versus Strip Craniectomy for Metopic Synostosis: A Comparison of Treatment Timelines and Craniometrics in the First Postoperative Year

Share

COinS