The nautilus technique: spiral osteotomy for cranial reconstruction

Introduction: Craniosynostosis, the premature fusion of the cranial suture, is still a common condition in pediatric neurosurgery. Several techniques have been described to treat different types of craniosynostosis. Here we describe our experience using the spiral osteotomy, also known as the Nautilus technique, for cranial reconstruction in different forms of craniosynostosis.

Methods: A retrospective study with total of 17 patients was conducted. Inclusion criteria were cranial deformity post previous treatment, complex craniosynostosis (more than one suture involved), syndromic craniosynostosis and trigonocephaly. Variables related to the surgical procedure included time of the surgical procedure, blood transfusion, period in the ICU, and in hospital staying were analyzed. Cranial vault metrics were recorded preoperative and postoperative. Descriptive statistics were used to describe the data.

Results: Overall patients presented with moderate pain during first 12 hours post-operative, which responded to non-opioid pain relief. Periorbital edema was observed in all patients, particularly in those that required fronto-orbital advancement. ICU period ranged from 1 to 3 days and in-hospital staying ranged from 3 to 6 days. Improved cranial remodeling was observed on day-1 in all cases on CT scans.

Conclusion: The Nautilus technique proved to be a less invasive technique for selected cases of craniosynostosis with good results. Advances in operative procedures will continue to evolve, particularly with new training methods and surgical models based on 3D printing. The spiral osteotomy has the potential to treat different forms of craniosynostosis with minimal parenchymal exposure, less operative time and improved postoperative recovery.