Removal of cranial springs after spring-mediated cranioplasty

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  • 1 Divisions of Plastic and Reconstructive Surgery and
  • 2 Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
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Cranial spring hardware is generally removed 3 months after placement for spring-mediated cranioplasty. Spring removal is performed as an outpatient procedure under general anesthesia in approximately 15 minutes through the incision locations of the index procedure. Herein, the authors provide a multimedia demonstration of cranial spring hardware removal after spring-mediated cranioplasty for sagittal craniosynostosis.

The video can be found here: https://vimeo.com/511179695

Cranial spring hardware is generally removed 3 months after placement for spring-mediated cranioplasty. Spring removal is performed as an outpatient procedure under general anesthesia in approximately 15 minutes through the incision locations of the index procedure. Herein, the authors provide a multimedia demonstration of cranial spring hardware removal after spring-mediated cranioplasty for sagittal craniosynostosis.

The video can be found here: https://vimeo.com/511179695

Transcript

0:25 Timeline. Cranial springs are generally removed approximately 3 months after placement for sagittal craniosynostosis, which reflects several weeks of active expansion followed by about 2 months of consolidation.1–8

0:42 Local Anesthesia. After general endotracheal anesthesia is induced, local anesthesia containing epinephrine is infused in the patient's scalp incision. The patient is generally left in supine position.

0:52 Incision. After prep and drape, the previous scalp incisions are opened to the subgaleal plane, with care taken to protect the underlying cranial bone regenerate.

1:00 Subgaleal Undermining. Subgaleal undermining is performed over the midportion of the springs.

1:07 Dissection of Spring Arms. Dissection of each of the spring arms is performed to its footplate using tenotomy scissors and Obwegeser elevator.

1:13 Springs Elevated and Cut. Each spring is elevated off of the regenerate and then cut with heavy wire cutters in the midline.

1:19 Springs Removed. Each hemispring is carefully isolated from its surrounding soft tissue. Heavy needle driver is used to grasp each spring near its footplate; then the spring is axially rotated so that the footplate is retracted from its subcranial position and the hemispring is removed. Rarely, a Kerrison or narrow rongeur can be used to remove cranial bone immediately adjacent to the footplate if it does not easily retract.

1:47 Irrigation. Once all springs are removed, the subgaleal space is irrigated and hemostasis assured.

1:55 Closure. Layered closure of galea with 3-0 Vicryl and skin with 4-0 plain gut is performed. The spring removal procedure can be performed efficiently in approximately 15 minutes.

2:06 Dressing. Bacitracin is applied and a head wrap is optional.

Author Contributions

Primary surgeon: Lang, Swanson, Storm, Taylor. Assistant surgeon: Lang. Editing and drafting the video and abstract: Lang, Kalmar, Swanson, Shakir, Storm, Heuer. Critically revising the work: all authors. Reviewed submitted version of the work: Lang, Kalmar, Shakir, Kennedy, Heuer, Bartlett, Approved the final version of the work on behalf of all authors: Lang. Supervision: Lang, Bartlett. Filming of video: Kalmar.

References

  • 1

    Arko L IV, Swanson JW, Fierst TM, . Spring-mediated sagittal craniosynostosis treatment at the Children's Hospital of Philadelphia: technical notes and literature review. Neurosurg Focus. 2015;38(5):E7.

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  • 2

    Lauritzen C, Sugawara Y, Kocabalkan O, Olsson R. Spring mediated dynamic craniofacial reshaping. Case report. Scand J Plast Reconstr Surg Hand Surg. 1998;32(3):331338.

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  • 3

    Shakir S, Humphries LS, Kalmar CL, . Hope springs eternal: insights into the durability of springs to provide long-term correction of the scaphocephalic head shape. J Craniofac Surg. 2020;31(7):20792083.

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  • 4

    David LR, Plikaitis CM, Couture D, . Outcome analysis of our first 75 spring-assisted surgeries for scaphocephaly. J Craniofac Surg. 2010;21(1):39.

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    • Export Citation
  • 5

    David LR, Proffer P, Hurst WJ, . Spring-mediated cranial reshaping for craniosynostosis. J Craniofac Surg. 2004;15(5):810818.

  • 6

    Lauritzen CGK, Davis C, Ivarsson A, . The evolving role of springs in craniofacial surgery: the first 100 clinical cases. Plast Reconstr Surg. 2008;121(2):545554.

    • Search Google Scholar
    • Export Citation
  • 7

    Rodgers W, Glass GE, Schievano S, . Spring-assisted cranioplasty for the correction of nonsyndromic scaphocephaly: a quantitative analysis of 100 consecutive cases. Plast Reconstr Surg. 2017;140(1):125134.

    • Search Google Scholar
    • Export Citation
  • 8

    van Veelen ML, Mathijssen IM. Spring-assisted correction of sagittal suture synostosis. Childs Nerv Syst. 2012;28(9):13471351.

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Contributor Notes

Correspondence Shih-Shan Lang: Children's Hospital of Philadelphia, PA. chens4@email.chop.edu.

C.L.K. and J.W.S. contributed equally to this work.

INCLUDE WHEN CITING DOI: 10.3171/2021.1.FOCVID20102.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication.

  • 1

    Arko L IV, Swanson JW, Fierst TM, . Spring-mediated sagittal craniosynostosis treatment at the Children's Hospital of Philadelphia: technical notes and literature review. Neurosurg Focus. 2015;38(5):E7.

    • Search Google Scholar
    • Export Citation
  • 2

    Lauritzen C, Sugawara Y, Kocabalkan O, Olsson R. Spring mediated dynamic craniofacial reshaping. Case report. Scand J Plast Reconstr Surg Hand Surg. 1998;32(3):331338.

    • Search Google Scholar
    • Export Citation
  • 3

    Shakir S, Humphries LS, Kalmar CL, . Hope springs eternal: insights into the durability of springs to provide long-term correction of the scaphocephalic head shape. J Craniofac Surg. 2020;31(7):20792083.

    • Search Google Scholar
    • Export Citation
  • 4

    David LR, Plikaitis CM, Couture D, . Outcome analysis of our first 75 spring-assisted surgeries for scaphocephaly. J Craniofac Surg. 2010;21(1):39.

    • Search Google Scholar
    • Export Citation
  • 5

    David LR, Proffer P, Hurst WJ, . Spring-mediated cranial reshaping for craniosynostosis. J Craniofac Surg. 2004;15(5):810818.

  • 6

    Lauritzen CGK, Davis C, Ivarsson A, . The evolving role of springs in craniofacial surgery: the first 100 clinical cases. Plast Reconstr Surg. 2008;121(2):545554.

    • Search Google Scholar
    • Export Citation
  • 7

    Rodgers W, Glass GE, Schievano S, . Spring-assisted cranioplasty for the correction of nonsyndromic scaphocephaly: a quantitative analysis of 100 consecutive cases. Plast Reconstr Surg. 2017;140(1):125134.

    • Search Google Scholar
    • Export Citation
  • 8

    van Veelen ML, Mathijssen IM. Spring-assisted correction of sagittal suture synostosis. Childs Nerv Syst. 2012;28(9):13471351.

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