Pseudomeningocele in the Setting of Spring-Assisted Strip Craniectomy for Sagittal Craniosynostosis: A Case Report

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-9-2025

Abstract

Sagittal craniosynostosis, the premature fusion of the sagittal suture, leads to scaphocephaly and potential neurodevelopmental concerns, necessitating surgical intervention. Minimally invasive techniques offer reduced blood loss, shorter operative times, and comparable aesthetic outcomes to open correction. Among these, spring-assisted strip craniectomy has gained prominence for its ability to harness dynamic remodeling forces via implanted springs. While associated with fewer complications, the unique biomechanical forces may predispose patients to dural tension. This report presents a rare case of pseudomeningocele following spring-assisted craniectomy, aiming to explore the role of spring-induced forces on the dura and their contribution to this complication.

A 6-week-old term male presented for evaluation of abnormal skull shape, noted at birth without signs of increased intracranial pressure. He had no genetic syndromes, prior surgeries, or relevant family history. Examination showed a closed posterior fontanelle, scaphocephaly with narrowed biparietal distance, frontal bossing, and occipital bulleting. Skull CT confirmed sagittal suture craniosynostosis with mild dolichocephaly and no intracranial anomalies. Cranial vault reconstruction was recommended to prevent impaired brain development, increased intracranial pressure, and for aesthetic correction. The family elected surgery, and the patient underwent preoperative anemia optimization per institutional protocol.

At three months, the patient underwent sagittal strip craniectomy with cranial spring placement, including sagittal suture resection and two 7N springs. No dural injury was noted intraoperatively. On post-op day 2, he developed fever, tachycardia, and a left occipital fluid collection, which was drained and managed with cefazolin. A persistent fluid collection led to elective spring removal and dural repair at six weeks post-op. MRI revealed a leptomeningeal cyst (7.6 x 4.3 x 0.8 cm). By 17 days post-removal, the fluid reaccumulated, increasing to 7.9 x 5.4 x 3.2 cm by day 20, requiring aspirations, head wraps, and acetazolamide, which was denied by insurance. CSF analysis showed no infection. The patient was fitted with an orthotic helmet for decompression. Throughout, he remained well without infection or neurological deficits. Future posterior vault reconstruction is planned.

Spring-assisted strip craniectomy for sagittal craniosynostosis can lead to rare complications like pseudomeningocele. The lateral forces from the springs, combined with growing skull fracture from CSF pulsations, may contribute to dural tension and fluid accumulation. In this case, the patient developed persistent posterior CSF collection, highlighting a unique, rare complication where spring-induced forces are a plausible cause of dural fluid accumulation in spring-assisted procedures.

Comments

2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1735

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