Treating Craniosynostosis
We understand that you may be feeling anxious about your child’s diagnosis and treatment. At Cincinnati Children’s, experienced, expert surgeons and our nurse program coordinator will support you every step of the way.
Once we determine your child’s type of craniosynostosis, our team will work with you to develop the right treatment plan for your child’s needs. Craniosynostosis treatment involves surgery to open and expand the fused skull bones. Craniosynostosis surgery recommendations will depend on your child’s age and specific diagnosis.
While some procedures are time sensitive, we won’t rush decisions. We want to create a safe, effective plan that is tailored to your child’s specific needs.
Minimally Invasive Craniosynostosis Surgery and Helmet Therapy
Depending on your child’s age and diagnosis, we may be able to use minimally invasive craniosynostosis surgery. We only consider these treatments for children younger than six months.
If your child is a good candidate for minimally invasive surgery, we will schedule them for surgery right away.
After minimally invasive surgery, your child will wear a custom-made helmet for a few months. The helmet will gently mold your child’s head into a more natural shape as the brain grows.
Minimally invasive craniosynostosis surgery options can include:
Endoscopic Craniectomy or Strip Craniectomy
We may use endoscopic craniectomy for various types of craniosynostosis. Although we often use this surgery to open the skull’s sagittal suture, we can use it to open any of the skull sutures.
During the surgery, the surgeon makes small incisions on the top of your baby’s head. The surgeon will perform the operation using small tools on the end of a thin tube with a camera (endoscope). After making the incisions, the surgeon will remove a piece of skull bone with the fused suture inside. This piece of bone is usually about 2 inches wide.
Along with the endoscope, the surgeon will use your child’s CT scan images to help guide the surgery.
Cranial Springs
Cranial springs surgery combines a strip craniectomy procedure with the placement of stainless-steel springs. This procedure is also called spring-mediated cranioplasty. It’s sometimes called sagittal springs when it’s used to open the sagittal suture.
With this procedure, the surgeon will make small incisions in the top of your baby’s head. Then, using an endoscope and small tools, the surgeon will remove a strip of skull bone that includes the fused suture. After that, the surgeon will place the steel springs in the newly opened suture. This will create more space for the brain to grow and reduce the risk of the suture closing again.
The surgeon will remove the springs a few months later during a separate surgery. Springs eliminate the need for your baby to wear a molding helmet.
Open Craniosynostosis Surgery
If your child needs open surgery, we’ll use our virtual surgical planning (VSP) technology before their surgery and while in the operating room. This allows us to better prepare for your child’s surgery, so we know every step we’ll need to take during the operation. The VSP will also give you a picture of what your child’s head shape will look like after the procedure.
The type of craniosynostosis surgery we choose for your child will depend on the specific diagnosis and can include:
Cranial Vault Reconstruction (CVR)
This procedure reshapes and expands skull bones. We may do cranial vault reconstruction on the entire skull or in individual sections. For example, if your child has fused bones at the back of the skull, we may use a version of this procedure called posterior vault remodeling or posterior vault reshaping. If we use this procedure on the front part of the skull, it’s called anterior vault remodeling or anterior vault reshaping.
During a cranial vault reconstruction, the surgeon will make an incision across the top of your baby’s head from ear to ear. Then, the surgeon will remove pieces of the skull near the fused suture. After removing the bone, the surgeon will reshape it and re-attach it to the skull. The surgeon will use dissolvable plates or sutures to make sure the reshaped skull bone stays in place.
Sometimes this procedure is called vault reconstruction, cranial vault remodeling or cranial reconstruction.
Cranioplasty
This surgery repairs skull anomalies or holes. These holes may be something a child is born with (congenital) or they can be caused by a traumatic injury or surgery. We may repair the skull with your child’s original bone (autologous cranioplasty) or use artificial bone (skull alloplast implant).
During a cranioplasty, the surgeon will make an incision on the top of your baby’s head to access the skull. Then, the surgeon will clean and prepare the part of the skull with the anomaly or hole. Once the surgeon preps the area, they will secure the bone implant with screws, plates or sutures.
Distraction
We use this surgery to help expand part of the skull. In most cases, we use it to expand the back of the skull, which is called posterior vault distraction (PVR).
During the procedure, the surgeon will make an incision on the top of your baby’s head. Then, the surgeon will remove a piece of the skull and insert a medical device that’s secured by screws. The device allows the skull to increase in size. Once enough bone grows back, the surgeon will remove the screws and device.
Most kids who undergo posterior vault distraction go on to have other surgeries, such as cranial vault reconstruction (CVR). This surgery is also called cranial vault distraction or cranial distraction.
Fronto-Orbital Advancement (FOA)
This procedure reshapes the skull bone around the forehead. It is often used to treat older infants who have severe metopic synostosis or coronal synostosis. We may also use a Fronto-Orbital Advancement to treat multisuture craniosynostosis.
Some patients may undergo a fronto-orbital advancement after a cranial vault reconstruction . Patients who have eye problems, because of craniosynostosis, may have an FOA before other surgeries.
During a fronto-orbital advancement, the surgeon will make an incision across the top of your baby’s head from ear to ear. Then, the surgeon will remove pieces of skull bone from above the eyes to behind the forehead. The surgeon will reshape the eye socket and forehead bone and place it back on the skull, allowing the brain more room to grow. The surgeon will secure the bone with resorbable plates and screws.
After Craniosynostosis Surgery
After surgery, your child may spend some time in the intensive care unit (ICU). Once your child is out of the initial recovery period, we will move them to a different floor in the hospital. Most kids stay in the hospital between one and five nights, depending on their type of surgery.
Once your child leaves the hospital, you’ll come back for a follow-up appointment with your surgeon two weeks later. For children who undergo minimally invasive surgery, this first check-in will be with our neurosurgeon. Kids who undergo open surgery will have this first check-in with our plastic surgeon.
Most children who undergo open surgery will return for a three-month check-up. After that, we’ll schedule yearly check-ins until your child is about 6 years old. Each of these check-ins will include both our plastic surgeons and neurosurgeons.
If your child underwent minimally invasive surgery and needs a helmet, we’ll meet with you every three months until your child no longer needs the helmet. At each check-in, we’ll take images of your child’s head to track progress. Most kids need to wear a helmet until they are between 6 and 9 months out from surgery. Once your child finishes helmet therapy, we’ll schedule yearly follow-ups until your child is about 6 years old.
Our team will share all treatment details with your pediatrician or referring doctor. This process will help make sure you receive seamless care throughout your child’s development.
