Craniosynostosis repair

Alternative Names: Craniectomy; Synostectomy; Strip craniectomy; Endoscopy-assisted craniectomy; Sagittal craniectomy; Frontal-orbital advancement; FOA

Craniosynostosis repair is surgery to correct a deformity that causes the bones of a child's skull to grow together (fuse) too early.

Description of Procedure

This surgery is performed in the operating room under general anesthesia (your child will be asleep and will not feel pain).

Traditional surgery is called open repair. It includes these steps:

• The most common place for a surgical cut to be made is over the top of the head, from just above one ear to just above the other ear. The cut is usually wavy. The exact placement of the cut may be different for different problems.
• A flap of skin, tissue and muscle below the skin, and the tissue covering the bone are loosened and raised up so the surgeon can see the bone.
• A strip of bone is usually removed where two sutures connect. This is called a strip craniectomy. Sometimes, larger pieces of bone must also be removed. This is called synostectomy. Parts of these bones may be changed or reshaped when they are removed, and then they are put back in. Other times, they are removed and not put back in.
• Sometimes, bones that are left in place need to be shifted or moved.
• Bones are then fastened using a plate with screws that go into the skull.

Surgery usually takes 3 to 7 hours. Your child will probably need to have a blood transfusion during or after surgery to replace blood that is lost during the surgery.

A newer kind of surgery is used for some children. This type is usually done for children younger than 3 to 6 months old.

• The surgeon makes one or two small cuts in the scalp. Most times these cuts are each just 1 inch long. These cuts are made above the area where the bone needs to be removed.
• A tube that allows the doctor to see in (endoscope) is passed through the small cuts. Special medical devices and a camera are passed through the endoscope. Using these devices, the surgeon removes some bone through the cuts.
• This surgery usually takes about 1 hour. There is much less blood loss with this kind of surgery.
• Most children need to wear a special helmet to protect their head for a period of time after surgery.

Children do best when they have this surgery when they are 3 months old. The surgery should be done before the child is 6 months old

Risks of Craniosynostosis repair

Risks for any surgery are:

• Breathing problems
• Infection, including in the lungs and urinary tract
• Blood loss (children having an open repair may need a transfusion)
• Reactions to medicines

Possible risks of having this surgery are:

• Infection in the brain
• Brain swelling
• Damage to brain tissue

Review Date: 12/23/2010
Reviewed By: Charles J. Prestigiacomo, MD, FACS, Associate Professor, Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry New Jersey, Newark, NJ. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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