Craniosynostosis is premature or early fusion of a growth place in the skull. There are many growth plates, known as cranial sutures, in an infant. These are called metopic, coronal, sagittal, lamdoid and frontosphenoid cranial sutures.
Early fusion of one or more cranial sutures leads to plagiocephaly, which means deformed skull. Therefore, craniosynostosis has to be differentiated from positional plagiocephaly. While positional plagiocephaly is treated with tummy time and cranial orthotic helmet molding (for severe flattening), the deformation of the skull caused by craniosynostosis requires surgical treatment.
There are three surgical options to treat craniosynostosis: traditional, minimally invasive, and early interventional. Traditional surgical reconstruction is performed at 6 to 8 months of age. Minimally invasive and early intervention reconstruction is performed at 3 to 4 months of age.
Of the three techniques, I prefer the early intervention technique, which I created with Dr. Avinash Mohan and Dr. Michael Tobias, two exceptional pediatric neurosurgeons in Westchester, NY. Early intervention is a modification of the minimally invasive technique. Rather than using limited scalp incisions and using endoscopic instruments to perform the operation, the early intervention technique utilizes scalp incisions large enough to reconstruct the skull without needing endoscopic instruments. The rationale for this is that a scalp scar is well hidden by hair, especially if the scalp scar is designed well. By exposing the entire area of surgical treatment, we can easily make bony cuts in the skull precisely and have complete exposure during the operation. When a coronal or metopic craniosynostosis is moderate to severe, removal of the involved fused cranial suture alone may not correct the shape of the skull entirely. We have had tremendous success in treating craniosynostosis with this technique over the past 3 years. We have achieved great shape of the skull without the need for any plates and screws.
Minimally invasive technique has been popularized over the years by Dr. Jimenez in Texas. Many craniofacial and neurosurgeons have utilized this technique. Benefits of a minimally invasive technique is to limit a scalp scar and utilize the softness of the skull and the growth of the brain to mold the skull. No surgical plates or screws are needed. An orthotic cranial molding helmet is used postoperatively to achieve this molding process, usually until a child is one year of age. Some craniofacial surgeons do not want to use this technique because they fear inadequate correction of the deformity and the risk of blood loss at 3 to 4 months of age. These craniofacial surgeons are content with performing the traditional technique.
The traditional technique of treating craniosynostosis was created by a great french surgeon, Dr. Paul Tessier. The technique has evolved to using degradable plates and screws, which take about a year for the body to absorb. A bicoronal scalp incision is used. The fused cranial suture is removed. Then bone cuts are made in different areas depending on the type of craniosynostosis for skull reconstruction. The results of the operation are dependably good. However, recession of the skull in areas where the plates and screws are placed sometimes leads to a residual contour deformity of the skull. This may require a touch up operation, called a cranioplasty, to further improve the shape of the skull.
Treatment of craniosynostosis is important not only to improve head shape but increase space for the growing brain. An early assessment by both a pediatric craniofacial plastic surgeon and pediatric neurosurgeon is important to learn about the different treatment options.