Neurosurgery

  • Types of Craniosynostosis Surgery

    Minimally-invasive calvarial vault remodeling for single suture craniosynostosis

    Surgeons at Cincinnati Children's are leading the nation in refinements of minimally invasive craniosynostosis procedures. While most craniofacial centers use endoscopes and routine postoperative molding helmet applications for up to one year following surgery, our surgeons are achieving the same excellent results with less impact on children and their families.

    This procedure consists of remodeling the calvarial vault --that is, the entire top of the skull --through 2 or 3 small scalp incisions that become nearly invisible after healing. Extensive bone cuts are made and bone grafts manipulated underneath the scalp, effectively decreasing the trauma and limiting blood loss. Additionally, the use of special medications  such as tranexamic acid)  further decrease blood loss and prevent the need for blood transfusion or significantly reduce the amount required. A molding helmet is generally not prescribed, as most patients maintain excellent correction with proper positioning care (detailed instructions are provided to caregivers by our expert team members). Hospital stays are generally a few days and minimal pain medication is required after discharge.

    This procedure is performed between 6 weeks and 3 months of age.  Therefore, prompt referral to our center is paramount. We work closely with referring physicians to assure a timely evaluation and scheduling of surgery.

    Distractor-assisted and spring-assisted procedures

    Occasionally, Cincinnati Children's neurosurgeons and craniofacial plastic surgeons will apply metal devices to the skull through small scalp incisions to "advance" bones that are not growing in a proper fashion. This can be done as either a standalone procedure or to supplement other minimally invasive or open craniosynostosis procedures. Distractors require special care in the home setting.  Springs remain under the scalp and simply require an outpatient procedure for removal after the expected result has been achieved, generally 1-3 months later.

    Traditional “open” calvarial vault remodeling for single or multiple suture craniosynostosis

    This technique is used for children who are not candidates for the minimally invasive procedures. An incision is made over the top of the head from ear to ear and the scalp removed from the skull and regions where remodeling this required Bone cuts are made under direct visualization and bone grafts applied as needed to correct the deformity. The scalp is closed in such a way that scars are minimal after healing. Although this produces slightly more swelling, discomfort, and longer hospital stays, children are still discharged to home on minimal pain medications with few special care instructions.

    Frontal-orbital Advancement (FOA)

    This procedure is recommended for older infants with craniosynostosis that affects the eye sockets, such as severe metopic synostosis or coronal synostosis. An incision is made over the top of the scalp from ear to ear. The bone of the skull is removed from above the eyes to behind the forehead. The bone is reformed and then replaced. The eyes will become swollen over the first 12 to 24 hours and may be swollen shut for two to three days. As soon as the eyes are open, the blood counts are stable, there is no fever and the child is eating well they may go home. The length of hospital stay is usually five to seven days. Absorbable mesh and plating material, as well as flexible bone graft material allow the surgeons to create a very stable reconstruction, providing confidence to caregivers that nothing other than normal "baby handling" is required in the postoperative period. Generally minimal pain medication is required after discharge and the swelling resolves within 7-10 days.