Interrelations Between Surgical Outcome and Bone, Spring and Surgical Parameters in Scaphocephalic Skulls Treated with Spring-Assisted Cranioplasty

Sagittal synostosis is the most common type of craniosynostosis encompassing around 50% of craniosynostosis conditions. It can be corrected using spring-assisted cranioplasty in which springs are compressed at both ends and inserted into the skull to expand it. Although it has advantages over open surgical techniques the surgical outcome may remain suboptimal due to the interaction of skull, spring and surgical parameters. Therefore, optimizing the surgical outcome in the correction of sagittal synostosis with spring-assisted cranioplasty requires understanding the interaction of multiple factors. In this study, the interrelations between the surgical outcome and skull, spring and surgical parameters in sagittal synostosis treated with spring-assisted cranioplasty are investigated. Two different statistical shape models are used to simulate skull correction with spring-assisted cranioplasty. Forty samples for each parameter are generated randomly and spring-assisted cranioplasty are simulated in finite element models using the combinations of the parameters. Linear regression analyzes revealed that the elastic modulus of the bones and bone thickness have significant effects on the post-operative cranial index in sagittal synostosis after spring-assisted cranioplasty. Therefore, quantifying the mechanical and geometric properties of a skull and planning the surgery accordingly may ultimately improve surgical outcomes in sagittal synostosis corrected with spring-assisted cranioplasty.