Your child’s skull is made up of five major skull bones. Between them are growth plates called sutures. The baby’s brain grows rapidly during the first year of life, and the sutures allow space for the bones to stretch and expand.
What Is Craniosynostosis?
Craniosynostosis occurs when one or more of the sutures fuse abnormally, causing problems with skull and brain growth. Abnormal closure of the sutures can cause pressure on the brain and can cause the skull and facial bones to change, giving the child an abnormal head shape. In some children, craniosynostosis can be associated with a genetic syndrome.
The diagnosis of craniosynostosis is made based on physical exam and confirmed with imaging studies: X-rays and head CT. Our team receives referrals from pediatricians, orthotists, geneticists and other specialists to evaluate infants and children with skull shape deformities. We also evaluate and treat children and adults who may have had previous surgical repair for craniosynostosis and need to establish ongoing care.
Albert Woo, MD, chief of plastic surgery at Hasbro Children’s Hospital, highlights a unique and minimally-invasive surgical procedure for metopic synostosis in infants.
If you have concerns about the shape of your newborn baby's head, contact a specialist as soon as possible.
The endoscopic procedure to correct craniosynostosis is only possible when the baby is three to four months old, so it’s crucial to assess the infant early.
Surgical Options for Craniosynostosis
There are two surgical approaches to correcting craniosynostosis.
Endoscopic strip craniectomy surgery is a less invasive surgical option for infants with craniosynostosis diagnosed before 3 months of age. The procedure is done together by a plastic surgeon and neurosurgeon. The doctors make one to two small incisions on the top of the head. A small camera and instruments are placed through the incisions to remove the abnormal strip of fused bone. Most infants have minimal blood loss and usually do not need a blood transfusion. Children are admitted to the hospital for one to two days. Your child will need to wear a helmet after surgery to help reshape the skull deformity. You will meet with the orthotist, a therapist who makes and adjusts the helmet, before and after surgery. Typically, the baby starts wearing the helmet the day after surgery. The helmet is worn 23 hours per day until the child is about one year of age.
Open or cranial vult reconstruction surgery is performed on children with craniosynostosis at any age. The procedure is done together by a plastic surgeon and neurosurgeon. The doctors make a long zig zag incision over the top of the scalp. The skull is reconstructed by making a series of cuts in the bone that allow the surgeon to reshape the skull. Sometimes the doctors use dissolvable plates and screws to hold the bones of the skull in place. Immediately after surgery, the skull shape is improved and will continue to improve over time. Many children will need a blood transfusion and are admitted to the hospital for three to five days. The child does not need to wear a helmet after the open procedure.
Endoscopic Strip Craniectomy
- Surgery is done by three months of age
- Surgery is one to two hours
- Patients usually do not need a blood transfusion
- Hospital stay is usually one to two days
- There are two small scars
- Infants wear a helmet until one year of age to help change the skull shape. This requires frequent visits to the orthotist.
Open Cranial Vault
- Surgery may be done at any age
- Surgery is three to seven hours
- It usually requires blood transfusion
- Hospital stay is usually three to five days
- There is a long scar over top of scalp, but is usually well covered by hair within six months
- No need for helmeting after surgery
Please review the following post-operative instructions. In order to prevent injury, promote healing, and maintain your child's comfort, it is important that you follow these guidelines for the first several weeks after your child’s surgery.
(All links are to PDF documents.)