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Pediatric Craniosynostosis Surgery: What You Should Know

Scan of craniosynostosis affecting a child's skull

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In pediatric craniosynostosis, an infant’s skull “joints” fasten too early, and restrict skull and brain growth. This causes an abnormal head shape, which is often how parents are first alerted to something amiss.

This condition is often diagnosed in very young infants, and doctors may recommend surgery. It’s natural to feel anxiety about surgery for a small baby.

However, surgery for this condition is highly successful. Johns Hopkins pediatric neurosurgeon Edward Ahn, M.D., has seen the effects of craniosynostosis treatment: happy, healthy children and then teenagers, with hardly a scar to show from such early obstacles.

Pediatric Craniosynostosis Surgery: Traditional Approach

Your doctor will be able to discuss treatment specifics that apply to your child. One treatment method your doctor may use is traditional open surgery.

Calvarial vault remodeling: This is the surgical approach that doctors have relied on for decades to treat craniosynostosis. Because it is more invasive, it’s best suited for babies over 6 months of age.

In this surgery, a team of doctors:

  1. Makes an incision along a baby’s scalp.
  2. Removes the affected bone.
  3. Reshapes and replaces the bone to allow for normal growth.

Pediatric Craniosynostosis Surgery: Minimally Invasive Approach

Today, Johns Hopkins neurosurgeons provide a newer, less invasive approach to surgery that offers much less risk.

Endoscopic surgery: This approach is best for babies up to 3 months old, when their skull bones are most pliable. During this surgery, doctors:

  1. Make very tiny incisions in a baby’s scalp. At Johns Hopkins, we’ve developed a single-incision technique that reduces complications, such as bleeding, and leaves less of  a scar.
  2. Use an endoscope, a flexible, thin tube with a light, to see the inside of the scalp.
  3. Remove the affected bone.

After an endoscopic surgery, your child will need to wear a helmet for a period of time. This helps to mold the head into a normal shape as it continues to grow. Within a year:

  • Your child’s scar will be almost invisible.
  • The head shape should be normal.

Craniosynostosis Surgery: Traditional Versus Endoscopic

Many centers still perform the traditional surgery today. The surgery is immensely safer than it was in previous decades. Still, it’s an invasive procedure for babies who are diagnosed at 3 months of age or younger.

The procedure can take eight hours. Babies are often in the ICU  for the first 24 hours after surgery so the team can monitor them carefully. Another four to five days in the hospital’s pediatric unit is normal after this surgery.

Doctors pay particular attention to:

  • How sedation will affect your child
  • How to combat any blood loss from the surgery

In comparison, the endoscopic procedure, performed on babies 3 months old or younger, shows excellent results with fewer risks, including:

  • Less blood loss during surgery
  • A shorter hospital stay (one night)
  • Smaller incisions
  • Improved results over open treatments: For example, babies undergoing the traditional surgery sometimes have their skull bones revert back to abnormal growth patterns. This can require a second surgery to correct the issue again.

Your doctor can help you determine which treatment is best for your child.

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