Craniosynostosis

Types of Craniosynostosis We Treat

Craniosynostosis is a group of disorders in which the sutures of the skull fuse together too soon. When a baby is born, the skull has not yet fully fused together, leaving sutures (long, narrow openings) along the head. These sutures help the baby exit the birth canal and leave room for proper brain and head development.

Our team provides expert diagnosis and advanced treatment for all types of craniosynostosis. Types of this condition include:

• Coronal Craniosynostosis: This premature fusing of one of the skull sutures can lead to a flattened forehead on the side of the head where the suture closed too soon.
• Bicoronal Craniosynostosis: In babies born with this condition, both sutures of the skull (which run from the ears to the soft spot-on top of the head) fuse too soon. This leads to an unusually flat, wide and tall head.
• Boston Type Craniosynostosis: This genetic disorder causes a high, prominent forehead, and sometimes leads to extra teeth and unusual formations of the hands and feet.
• Metopic Craniosynostosis: The metopic ridge is the suture line that runs from the top of the head down the forehead; it is typically still open at birth. In babies born with this condition, the metopic ridge closes before birth. This may create a noticeable ridge running down the forehead. In some cases, the forehead looks pointed like a triangle and the eyes are close together. Another name for this condition is trigonocephaly.
• Sagittal Craniosynostosis: The sagittal suture runs from the top of the head down the back of the head; it is typically still open at birth. In babies born with this condition, the sagittal suture closes too early, which causes the head to appear long and narrow.

Treatments for Craniosynostosis

Our craniofacial team is proud to offer the latest in research-backed treatment options for your child. Your child’s doctor may recommend treating craniosynostosis with traditional surgery, such as cranial vault remodeling (CVR), or with a minimally invasive surgery.

Virtual Surgical Planning (VSP)

Our surgeons use VSP to carefully plan our surgical procedures. Your child’s surgeon uses computerized tomography (CT) imaging to create a 3D model of your child’s head to determine the best course of action for their treatments. By using VSP, we can often offer:

• Reduced surgery time
• Greater precision
• Less time under anesthesia

Endoscopic surgeries are typically less invasive by using smaller incisions, which may mean faster healing and less downtime after surgery. Based on your child’s situation, their surgeon may be able to offer VSP for various craniofacial surgical procedures, including skull reconstruction.

Endoscopic Assisted Craniectomy

This procedure treats some types of craniosynostosis or early fusion of skull bones in babies. Surgeons perform endoscopic assisted craniectomy (EAC) only on babies younger than four months old. During this procedure, the surgeon removes the area of prematurely fused bone.

Following surgery, your baby will need to wear a post-surgical helmet for several months. This helmet helps mold the head to a shape that better accommodates normal brain growth. This procedure is also known as a strip craniectomy or minimally invasive surgery for craniosynostosis.

Cranial Vault Remodeling

The craniofacial team at Joe DiMaggio Children’s Hospital is a regional leader in craniofacial vault remodeling surgery (CVR) for children with craniosynostosis. CVR is also known as

• vault reconstruction,
• cranial vault reconstruction, and
• cranial reconstruction.

Depending on your child’s exact condition and unique situation, our team may be able to perform less invasive, endoscopic CVR. However, our team is also very experienced in performing traditional, open CVR.

Endoscopic CVR

This new technique for treating craniosynostosis is minimally invasive. During this procedure, your child’s craniofacial surgeon uses incisions smaller than 2 centimeters long to access and repair the misshapen skull. The surgeon inserts a specialized set of instruments through these incisions and uses them to reshape the skull without making a large, ear-to-ear incision.

Compared to open CVR, the advantages of endoscopic CVR may include:

• Shorter hospital stays (often by several days)
• Decreased operation time
• Less blood loss (often preventing the need for a blood transfusion during surgery)
• Less swelling after the operation
• No internal screws or plates are required to hold the bone in place after surgery, reducing the risk of plate-induced pain, infection, swelling or allergic reaction
• Reduces pain during recovery

After your child undergoes endoscopic craniosynostosis repair, they must wear an FDA-approved corrective helmet (or molding band) to help maintain the new shape of their skull. Immediately after the surgery, you will notice a significant improvement in your child’s head shape. However, they will not achieve their final head shape until after 6 to 8 months of helmet therapy.

Open CVR

In a traditional open procedure, the surgeon uses a few large incisions to reach the surgical area. Open surgeries allow the surgeon to easily access and visualize the surgical site.

Surgeons typically use traditional, open CVR for children with single craniosynostosis, where one skull bone fuses too early during fetal development. During this procedure the surgeon removes the prematurely fused bone, reshapes and expands the area of the skull, and splits the removed bone and reattaches it to the reshaped area. The new skull shape provides more room for brain growth and improves the head shape.

We can also create custom, 3D modeling, computer assisted design (CAD) and computer assisted manufacturing (CAM), cranial implants as needed for specialized skull construction and cranial distraction springs.

Skull Distraction Surgery

This treatment uses a device to gradually move apart two areas of your child’s skull that were fused too early due to craniosynostosis. Your child’s treatment team will provide you with guidance and follow-up care to support the at-home portion of this treatment.

Spring Assisted Surgery

Your child’s surgeon removes a strip of bone in the suture that fused too early. The surgeon then places a surgical spring in between the skull plates to prevent them from fusing back together too soon. In most cases, this surgery is performed when a baby is around four months old. The springs typically stay in place for about four months; the surgeon can remove them in a quick, simple procedure.