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Neuro Innovations - A Kinder Operation for Craniosynostosis

Collaborations in Discovery

A Kinder Operation for Craniosynostosis

Date: November 1, 2011

Craniosynostosis surgery illustration
Medical illustrations by Tim Phelps, M.S., F.A.M.I., Associate professor and medical illustrator, Johns Hopkins Department of Art as Applied to Medicine; artwork copyright JHU 2008

Not long ago a couple brought their 3-month-old child to Johns Hopkins to see pediatric neurosurgeon Edward Ahn because the infant’s head wasn’t developing into a typical shape. The father thought he knew why—because he himself had been born with the same condition: craniosynostosis. Correcting it in the father had been an ordeal, but the infant in Ahn’s office would have a very different experience.

“We’ve been making huge changes in how we treat this condition here at Hopkins,” says Ahn.

The several bony plates that make up the skull are normally not yet attached to one another in a newborn, allowing the infant’s head to expand in all directions in the coming months to accommodate the rapidly growing brain. In babies with craniosynostosis plates fuse prematurely, constricting skull growth in one direction and forcing the skull to compensate by growing excessively in other directions.

The traditional treatment, typically performed when a child is between 6 months and a year old, is surgery to break up and reconstruct the plates. It’s a long operation requiring an ear-to-ear incision as well as transfusions to compensate for considerable blood loss. “It’s a week in hospital, and it may require additional surgeries to improve the results,” says Ahn. “Neurosurgeons really wanted to rethink the approach.”

Today Ahn needs to make only two tiny incisions on an infant’s head to accommodate the camera of an endoscope and a tiny cutting tool for removing a thin strip between the plates to free them. The procedure is so fast and neat that transfusions usually aren’t required, and the infant can go home the next day. And it can be performed on children as young as 2 months, an age at which all the plates are still shifting.

Following the operation, the child is fitted with a helmet that helps mold the head into a perfectly normal shape over the next nine or so months. “The babies don’t mind the helmet,” says Ahn. “It just becomes part of their normal life for a while.” That father certainly agreed: It’s a small price to pay for a big, lifelong improvement.

  • Challenge: Repair abnormal skull growth in infants whose skull plates fuse prematurely
  • Approach: Remove a small strip of the fused plates, and shape the skull with a helmet
  • Progress: The infant is home quickly, and the repaired skull looks perfectly normal

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