Comparison of Cranial Vault Remodeling Versus Spring Cranioplasty for Nonsyndromic Unicoronal Craniosynostosis: Analysis of Outcomes

Objective To compare outcomes of cranial vault remodeling via fronto-orbital advancement and remodeling (FOAR) versus spring cranioplasty in patients with nonsyndromic unicoronal craniosynostosis (UCS), focusing on surgical parameters and craniofacial symmetry improvements. Design Retrospective review comparing FOAR and spring-assisted cranioplasty outcomes using preoperative and postoperative CT data. Statistical analysis was performed using SPSS Statistics 30.0. Setting Institutional tertiary care center specializing in craniofacial surgery. Patients, Participants Nonsyndromic patients with UCS undergoing FOAR ( n = 7) or spring cranioplasty ( n = 11), with complete pre- and postoperative imaging and surgical data available. Interventions FOAR involved traditional fronto-orbital advancement and remodeling. Spring cranioplasty consisted of spring placement followed by spring removal surgery, designed to remodel cranial vault less invasively. Main Outcome Measure(s) Retrospective review of surgical time, estimated blood loss (EBL), packed red blood cells (PRBC) transfused, intracranial volume (ICV), facial twist (FT), skull-base twist relative to palate (SBT-P) and nasion (SBT-N), and orbital morphology symmetry. Results Spring cranioplasty, when considering both placement and removal, significantly reduced operative time (157.9 ± 28.6 vs 264.7 ± 48.3 min), EBL (5.5 ± 1.6 vs 26.5 ± 9.2 mL/kg), and PRBC transfusion (2 ± 4.2 vs 27.4 ± 5.9 mL/kg) compared with FOAR ( P < .001). Postoperatively, patients who underwent spring cranioplasty demonstrated significant improvements in FT, SBT-P, and SBT-N ( P = .003), whereas FOAR did not achieve significant changes. ICV did not differ significantly between groups. Spring cranioplasty patients demonstrated superior orbital symmetry improvement. Conclusions Spring cranioplasty offers a less invasive alternative to FOAR for UCS, with shorter surgery, less blood loss, and better craniofacial symmetry correction without compromising ICV expansion.