Perioperative Outcomes of Spring-Assisted Cranioplasty, Distraction Osteogenesis Versus Conventional Expansion in Craniosynostosis: A Systematic Review and Meta-Analysis.

Objectives: This study compares perioperative outcomes between spring-assisted cranioplasty (SAC), distraction osteogenesis (DO) and conventional expansion in craniosynostosis surgery.

Design: Systematic review and meta-analysis.

Setting: Retrospective and prospective cohort.

Patients and participants: A comprehensive electronic search was conducted using PubMed/Medline, Scopus, Science Direct, EBSCO, Web of Science, and Cochrane Library, alongside Gray literature sources (SSRN, Scopus preprint, and MedRxiv). Publication bias was assessed and study quality was evaluated using the Newcastle Ottawa Scales (NOS).

Interventions: SAC or DO.

Main outcome measures: Blood loss and blood transfusion.

Results: Thirteen studies were included, with 7 studies comparing DO versus conventional and 6 comparing SAC vs conventional. All studies met eligibility criteria for meta-analysis, with study quality ranged from good to very good. Compared to conventional, the SAC or DO significantly reduced blood loss (MD = -190.42 mL), and blood transfusion (MD = -227.22). Additionally, SAC and DO shorten operative time (MD = -94.38 min), anesthesia duration (MD = -114.81 min), hospital stay (MD = -0.68 days), and ICU stay (MD = -1.00 days). Long-term follow-up showed a lower reoperation rate (OR = 0.20), but no significant change in cranial index at 10 years (MD = 0.06, P = .74).

Conclusions: SAC or DO result in lower perioperative complications, overall shorter durations, and reduced reoperation rates compared to conventional expansion. Standardized postoperative outcome reports are useful to classify the severity of complications and guide the future long-term treatment strategies for craniosynostosis surgery.