Craniosynostosis repair

Definition

Craniosynostosis repair is surgery to fix damage caused by a birth defect that makes the bones in a child's skull grow together too early.

Alternative Names

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

Description

A baby's head, or skull, is made up of many different bones. The connections between these bones are called sutures. When a baby is born, it is normal for these sutures to be open a little. This gives the baby's brain and head room to grow.

Your baby was born with craniosynostosis, a condition that caused 1 or more of your baby's sutures to close too early. This can cause the shape of your baby's head to be different than normal. Sometimes it can cause brain damage.

An x-ray or computed tomography (CT scan) can be used to diagnose craniosynostosis. Surgery is usually needed to correct it. 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 an incision (a cut made during surgery) to be made is over the top of the head, from just above 1 ear to just above the other ear. The incision is usually wavy. The exact placement of the incision 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 2 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 while they are outside of the skull and then 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 put into place 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 1 or 2 small cuts in the scalp. Most times they are each just 1 inch long. These incisions are made above the area where the bone needs to be removed.
• An endoscope (a tube that allows the doctor to see in) 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 incisions.
• 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

Risks for any surgery are:

• Breathing problems
• Infection, including in the lungs, urinary tract, and chest
• 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