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.

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CORONAL CRANIOSYNOSTOSIS

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.

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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.

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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.

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