Spring-Assisted Cranioplasty for Metopic Craniosynostosis: Perioperative Metrics in Comparison to Fronto-Orbital Advancement and Strip Craniectomy

Objective This study compares perioperative outcomes of three operative approaches for metopic craniosynostosis: spring-assisted cranioplasty (SAC), strip craniectomy (SC), and fronto-orbital advancement (FOA). Design Retrospective cohort study. Setting Single-institution. Patients Patients with metopic craniosynostosis treated 2021 to 2024. Interventions SC, FOA, SAC. Main Outcome Measure(s) Perioperative data including blood loss, anesthesia duration, operative duration, hospital length of stay. For SAC, metrics for placement and removal were combined. Results Six patients underwent SAC, seven SC, and seven FOA at 4.77 (±1.22), 3.42 (±.46), and 11.38 (±3.65) months, respectively. FOA exhibited increased blood loss (median [IQR]; 200 mL [162.5, 250]), anesthesia time (328.86 min ±49.65) and operative time (230.86 min ±45.38) compared to SC (40 [20, 57.5]; P < .005; 153.29 ± 32.2; P < .001; 70.43 ± 20.11; P < .001) and SAC (50 [40,75]; P < .012; 254.17 ± 32.81; P < .012; 131 ± 24.5; P < .0010). Conclusions SAC for metopic craniosynostosis has lower blood loss, shorter operative time, and shorter anesthesia time in comparison to FOA. Total hospital stay duration required for SAC (including spring placement and removal procedures) is similar to FOA and greater than SC. Perioperative metrics for SAC are favorable or comparable relative to current standard-of-care procedures.