{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T02:01:28Z","timestamp":1788141688103,"version":"build-2803163510"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,5]]},"abstract":"\n OBJECT<\/jats:title>\n Sagittal craniosynostosis has been treated using both cranial remodeling techniques and modification of the sagittal strip craniectomy. A more recent technique is to implant springs in conjunction with a suturectomy to transversely expand the parietal bones to accommodate the growing brain. In this paper the authors describe and evaluate several modifications to the spring-mediated cranioplasty (SMC) technique, most notably use of an ultrasonic scalpel to limit dural dissection and maximize opening of the stenosed suture by placement of multiple spring devices. In addition, the literature is reviewed comparing SMC to other surgical treatments of sagittal synostosis.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors retrospectively reviewed patients who presented to the Children\u2019s Hospital of Philadelphia with a diagnosis of sagittal synostosis from August 2011 to November 2014. A pooled data set was created to compare our institutional data to previously published work. A comprehensive literature review was performed of all previous studies describing the SMC technique, as well as other techniques for sagittal synostosis correction.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Twenty-two patients underwent SMC at our institution during the study period. Patients were 4.2 months of age on average, had a mean blood loss of 56.3 ml, and average intensive care unit and total hospital stays of 29.5 hours and 2.2 days, respectively. The cranial index was corrected to an average of 73.7 (SD 5.2) for patients who received long-term radiological follow-up. When comparing the authors\u2019 institutional data to pooled SMC data, blood loss and length of stay were both significantly less (p = 0.005 and p < 0.001, respectively), but the preoperative cranial index was significantly larger (p = 0.01). A review of the SMC technique compared with other techniques to actively expand the skull of patients with sagittal synostosis demonstrated that SMC can be performed at a significantly earlier age compared with cranial vault reconstruction (CVR).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The authors found that their institutional modifications of the SMC technique were safe and effective in correcting the cranial index. In addition, this technique can be performed at a younger age than CVRs. SMC, therefore, has the potential to maximize the cognitive benefits of early intervention, with lower morbidity than the traditional CVR.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.3.focus153","type":"journal-article","created":{"date-parts":[[2015,5,1]],"date-time":"2015-05-01T03:36:59Z","timestamp":1430451419000},"page":"E7","source":"Crossref","is-referenced-by-count":62,"title":["Spring-mediated sagittal craniosynostosis treatment at the Children\u2019s Hospital of Philadelphia: technical notes and literature review"],"prefix":"10.3171","volume":"38","author":[{"given":"Leopold","family":"Arko","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Temple University;"},{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan W.","family":"Swanson","sequence":"additional","affiliation":[{"name":"Plastic Surgery, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara M.","family":"Fierst","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Temple University;"},{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary E.","family":"Henn","sequence":"additional","affiliation":[{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Temple University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip B.","family":"Storm","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania; and"},{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott P.","family":"Bartlett","sequence":"additional","affiliation":[{"name":"Plastic Surgery, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse A.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Plastic Surgery, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory G.","family":"Heuer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania; and"},{"name":"Divisions of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus153","series-title":"Neurosurgery","first-page":"329","article-title":"Operative normalization of skull shape in sagittal synostosis","volume":"17","author":"Albright","year":"1985"},{"key":"b2-focus153","series-title":"Childs Nerv Syst","article-title":"Novel use of an ultrasonic bone-cutting device for endoscopic-assisted craniosynostosis surgery","author":"Chaichana","year":"2013"},{"key":"b3-focus153","series-title":"J Craniofac Surg","first-page":"3","article-title":"Outcome analysis of our first 75 spring-assisted surgeries for scaphocephaly","volume":"21","author":"David","year":"2010"},{"key":"b4-focus153","series-title":"J Craniofac Surg","first-page":"810","article-title":"Spring-mediated cranial reshaping for craniosynostosis","volume":"15","author":"David","year":"2004"},{"key":"b5-focus153","series-title":"J Craniofac Surg","first-page":"151","article-title":"A technique for cranial bone expansion","volume":"7","author":"David","year":"1996"},{"key":"b6-focus153","series-title":"J Craniofac Surg","first-page":"177","article-title":"Cerebral perfusion defects secondary to simple craniosynostosis","volume":"7","author":"David","year":"1996"},{"key":"b7-focus153","series-title":"Childs Brain","first-page":"309","article-title":"Total vertex craniectomy for the treatment of scaphocephaly","volume":"9","author":"Epstein","year":"1982"},{"key":"b8-focus153","series-title":"Scand J Plast Reconstr Surg Hand Surg","first-page":"208","article-title":"Spring-mediated cranioplasty compared with the modified pi-plasty for sagittal synostosis","volume":"37","author":"Guimar\u00e3es-Ferreira","year":"2003"},{"key":"b9-focus153","series-title":"Plast Reconstr Surg","first-page":"491","article-title":"The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis","volume":"134","author":"Hashim","year":"2014"},{"key":"b10-focus153","series-title":"Teratology","first-page":"185","article-title":"Craniosynostosis. I. Sagittal synostosis: its genetics and associated clinical findings in 214 patients who lacked involvement of the coronal suture(s)","volume":"14","author":"Hunter","year":"1976"},{"key":"b11-focus153","series-title":"J Neurosurg","first-page":"705","article-title":"Immediate correction of sagittal synostosis","volume":"49","author":"Jane","year":"1978"},{"key":"b12-focus153","series-title":"J Neurosurg","first-page":"77","article-title":"Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis","volume":"88","author":"Jimenez","year":"1998"},{"key":"b13-focus153","series-title":"JAMA","first-page":"49","article-title":"Pioneer craniectomy for relief of mental imbecility due to premature sutural closure and microcephalus","volume":"18","author":"Lane","year":"1892"},{"key":"b14-focus153","series-title":"Compt Rend Seances Acad Sci","first-page":"1382","article-title":"De la craniectomie dans la microcephalie","volume":"50","author":"Lannelongue","year":"1890"},{"key":"b15-focus153","series-title":"Scand J Plast Reconstr Surg Hand Surg","first-page":"331","article-title":"Spring mediated dynamic craniofacial reshaping. Case report","volume":"32","author":"Lauritzen","year":"1998"},{"key":"b16-focus153","series-title":"Plast Reconstr Surg","first-page":"545","article-title":"The evolving role of springs in craniofacial surgery: the first 100 clinical cases","volume":"121","author":"Lauritzen","year":"2008"},{"key":"b17-focus153","series-title":"J Craniofac Surg","first-page":"129","article-title":"Evolution of surgery for sagittal synostosis: the role of new technologies","volume":"20","author":"Mackenzie","year":"2009"},{"key":"b18-focus153","series-title":"J Neurosurg","first-page":"610","article-title":"Intracranial volume change in childhood","volume":"91","author":"Sgouros","year":"1999"},{"key":"b19-focus153","series-title":"Pediatrics","first-page":"829","article-title":"Craniosynostosis: a review of 519 surgical patients","volume":"41","author":"Shillito","year":"1968"},{"key":"b20-focus153","series-title":"J Neurosurg Pediatr","first-page":"627","article-title":"Effect of molding helmet on head shape in nonsurgically treated sagittal craniosynostosis","volume":"7","author":"Sood","year":"2011"},{"key":"b21-focus153","series-title":"Childs Nerv Syst","first-page":"913","article-title":"Intracranial pressure monitoring in children with single suture and complex craniosynostosis: a review","volume":"21","author":"Tamburrini","year":"2005"},{"key":"b22-focus153","series-title":"J Craniofac Surg","first-page":"1225","article-title":"Comparison of spring-mediated cranioplasty to minimally invasive strip craniectomy and barrel staving for early treatment of sagittal craniosynostosis","volume":"22","author":"Taylor","year":"2011"},{"key":"b23-focus153","series-title":"Am Psychol","first-page":"5","article-title":"Developmental science and the media. Early brain development","volume":"56","author":"Thompson","year":"2001"},{"key":"b24-focus153","series-title":"Childs Nerv Syst","first-page":"1007","article-title":"Validation of cephalic index measurements in scaphocephaly","volume":"29","author":"van Lindert","year":"2013"},{"key":"b25-focus153","series-title":"Childs Nerv Syst","first-page":"1347","article-title":"Spring-assisted correction of sagittal suture synostosis","volume":"28","author":"van Veelen","year":"2012"},{"key":"b26-focus153","series-title":"J Neurosurg","first-page":"390","article-title":"Sagittal synostectomy. 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