A Less Invasive Technique for Babies with Craniosynostosis
The basic and fundamental principle with our Craniosynostosis treatment, is to operate on the baby with Craniosynostosis as early as possible. Best results are obtained when the infant receives the procedure by 12 weeks of age. However, successful skull reshaping can be achieved for older babies, with appropriate postoperative cranial helmet therapy.
Our approach is to release the prematurely closed suture and to allow the infant’s misshapen rapidly growing brain to remodel the skull and face to a normal shape. Depending on which suture is affected, our Craniosynostosis procedures have been designed to provide the most optimal results. Following surgery, the desired shape of the skull is attained with the use of custom made cranial helmets that are worn continuously by the infant over the ensuing months.
Sagittal Suture Craniosynostosis
The endoscopic treatment of sagittal craniosynostosis is done via two small incisions. One is placed behind the anterior fontanel (soft spot) and the other is placed further back on the infant's skull. The endoscopes are used to expose the areas above and below the skull, including the affected suture. Also, with endoscopic aid, the involved bone is removed, thereby freeing the baby's brain and skull to expand and reshape normally.
For Coronal Craniosynostosis, dissection endoscopic release of the closed coronal suture is performed via a small single incision located halfway between the baby's soft spot and the ear on the involved side. In all cases, only a very small amount of the infant's hair is removed. The stenosed suture is resected with bone cutting scissors and instruments. Unlike traditional craniosynostosis surgery, facial and orbital swelling is not seen and minimal pain is experienced by the patients.
Metopic Suture Craniosynostosis
The treatment of metopic suture synostosis is done via a single incision placed behind the infant's hair line and across the mid-line. The endoscopes are used to elevate the baby's scalp over the suture from the anterior fontanel down to the root of the nose (nasion). Once a small opening is made on the skull, the endoscopes are inserted under the bone and used to visualize the bone under the affected suture. A small strip of bone (0.7mm) is typically removed from the anterior fontanel to nasion, thereby releasing the closed stenosed suture.
Lambdoid Suture Craniosynostosis
For releasing stenosed lambdoid sutures, two one inch incisions are made in the back of the baby’s skull. One is made over the midline and the second one behind the affected ear. In a similar fashion, the stenosed lambdoid suture is removed with the aid and visualization of an endoscope. As with other sutures, the incisions are closed with subcutaneous absorbable sutures which do not require subsequent removal.
Muliple Suture Craniosynostosis
Much less common, a baby may be affected with premature closure of two or more sutures. This condition may be syndromic or non-syndromic in nature. However, the baby can still be successfully treated using endoscopic techniques that combine the removal of all involved sutures. Closure of both coronal sutures (Bicoronal Synostosis) is the most common multisuture that we treat with great, long lasting results.
Cranial Helmet Therapy
The Making of the Helmet
To maximize normalization and correction of your baby's cranial and facial deformities, specially crafted and designed custom made helmets are used after surgery and worn for a number of months. These helmets help guide brain development and promote growth in specific areas and apply gentle pressure in others. However, overall brain growth is NOT restricted in any way or form. Normal brain development takes place in all cases. Adjustments are made to the helmet over time to allow for rapid brain and head growth. Cushioning is used to to prevent the infant head from further flattening when tilted or resting on a flat surface. Made of plastic and foam, allergies to the helmet are rare.
We encourage you to start treatment as early as possible since the growth of the head begins to slow down after the first 12 months after birth. The average craniosynostosis treatment typically lasts 12 months with careful and frequent monitoring. However, this time frame is dependent on the age of your baby and severity of craniosynostosis.
Your infant’s cranial helmet will be manufactured by Orthomerica Products, Inc, the largest, most trusted cranial remolding manufacturer in the world. Currently, Orthomerica is one of only two manufacturers that have FDA clearance to construct this apparatus. These highly specialized custom cranial helmets require multiple design options, clinical expertise, and technology in order to achieve optimal clinical outcomes for the safety of your baby. The custom post-operative cranial remolding orthosis (cranial helmet) is a Class II device regulated by the FDA, which requires stringent quality, safety, and labeling information. In June of 2009, Orthomerica Products, Inc was awarded FDA approval.
Dr Jimenez does not have any financial interests or conflicts with Orthoamerica or any of the companies that make the endoscopes or instruments used in your baby's surgery.
Surgical treatment of craniosynostosis began in the 1890’s and multiple procedures have been developed and advocated for the treatment of this condition. In modern times, surgical correction of craniosynostosis is carried out by surgical craniofacial teams performing a variety of procedures which often times leads to successful correction of the associated deformities.
The “traditional” operation to treat craniosynostosis is carried out by making a scalp incision from ear-to-ear, mobilizing the infant’s scalp to expose the skull, total or sub-total skull removal, which is followed by reshaping and replacement of the skull with a variety of materials.
Craniosynostosis surgery typically takes three to seven hours, and often requires blood transfusions with hospitalization of three to five days. Extensive postoperative swelling is often seen after craniosynostosis surgery and can be associated with some pain and discomfort.
Resection or removal of the affected suture has been tried in the past with mixed results. Although results with these surgeries have indeed improved, the patients have paid a higher price in terms of increased swelling, pain, bleeding, blood transfusions rates, increased complications and longer hospitalizations.
Even though we have performed traditional craniosynostosis surgery for many years with very good results, our goals have been to decrease complications, surgical trauma and need for transfusions while obtaining excellent results that compare favorably or are even better than traditional craniosynostosis surgeries.