Surgery is the only effective treatment for craniosynostosis, because fused sutures must be opened to allow the brain to expand. This is not something that will happen naturally, and a child cannot “outgrow” craniosynostosis. A skilled surgeon must create new openings in the skull to allow for the rapid brain growth that takes place in the first year of life.
There are several surgical options for treating craniosynostosis. It’s usually best to perform surgery at just a few weeks to a few months of age, since the skull bones are the softest and most malleable then. The craniofacial team that evaluates a child will recommend the best surgery based on which suture closed prematurely, the degree of deformity, and the age of the patient.
In the simplest forms of single suture synostosis in a young infant, minimally invasive endoscopic surgery may be an option. An endoscope is a long tube that fits through tiny incisions. An attached light and camera allow a surgeon to see under the skin without having to make a large incision.
Although the results are excellent with either corrective form of surgical treatment (traditional cranial vault vs. endoscopic repair), there are many advantages to the minimally invasive approach:
• Shorter surgical time, including less time under anesthesia
• Smaller incision
• Reduced risk of infection
• Lower risk of blood loss and transfusion
• Shorter hospital stay
The minimally invasive approach is best for younger infants (typically less than four months of age), since the extremely rapid brain growth of early infancy helps reposition the cranial bones after surgery. The soft, malleable skull of a very young baby also makes it easier for a surgeon to open the sutures using only small incisions. After five months, a baby’s skull starts to become thicker and less malleable, making endoscopic visualization and manipulation more difficult.
Although all patients are evaluated on a case-by-case basis, younger babies are generally considered better candidates for endoscopic surgery and older babies usually undergo the traditional cranial vault approach.
Helmet therapy after endoscopic surgery helps reshape the baby’s head—see About Helmet Therapy for more information about helmets.
Open Surgical Procedure
Traditional open surgical procedures are described as cranial vault remodeling and vertex craniectomy; they are extremely safe and produce excellent results. In this surgery, a neurosurgeon removes the affected or closed suture and then “remodels” the skull. This type of surgery is offered to children older than four months of age or who have multiple suture craniosynostosis, where more than one suture has closed too early. The surgery usually takes between four and six hours and requires three to five days in the hospital, depending on the age of the child and which suture is involved. Some children need blood transfusions during the surgery.
No helmet therapy is needed after open cranial vault remodeling or vertex craniectomy.