In minor cases of craniosynostosis no treatment may be required, or helmeting may be recommended for a short period of time. In general, however, the preferred treatment for craniosynostosis is surgery. There are three main goals for all craniosynostosis surgeries:
- Improving physical appearance
- Allowing the brain to grow freely
- Relieving pressure on the brain
Ideally, a child with craniosynostosis will undergo surgery before they turn 1. If your child has a severe case, however, surgery may be necessary as early as 1 month of age. In cases that are not diagnosed until significantly later in life, but that present with complications such as swelling on the brain or seizures, surgery may also be considered.
When a very young infant receives cranial surgery, the procedure may be less invasive than what would be required to treat the same problem at a later stage. Since a child’s skull grows more slowly with age, and the sutures begin to fuse between 1-2 years of age, surgeries at or beyond this point may be much more complex.
Most craniofacial specialists and neurosurgeons agree that the ideal time for a child to undergo surgery for craniosynostosis is between 3 and 8 months of age.
Traditional surgical correction involves the correction of a craniosynostosis by moving the affected skull bone in a way that creates a more normal, rounded appearance. This type of surgery can be very long due to its complexity; lasting up to eight hours. It is not recommended for children under six months of age, due to the potential for blood loss.
A blood transfusion may be necessary during this type of surgery, so if either you or your partner is a blood-type match, you might look into donating blood for your child ahead of the procedure. Facial swelling is common after this type of surgery. Cranial vault remodeling (CVR), strip craniectomy, and Barrell Stave craniectomy are the most common traditional surgical methods for craniosynostosis. Of these, CVR is the most successful procedure, even for older children.
The benefit of this type of surgery is the lack of need for any follow up procedures, unless the craniosynostosis returns. Children who have traditional surgery do not need to wear cranial helmets following the procedure, although they may have plates, screws or other hardware installed as part of the procedure.
Endoscopic surgery is best for infants younger than 3 months of age, although it can be performed on babies as old as 6 months. It is a minimally invasive procedure that allows your child to go home within 24 hours on average. During endoscopic surgery, a neurosurgeon or craniofacial surgeon re-opens the closed suture on your baby’s head, allowing the bones to grow normally again. The surgery itself lasts about an hour, and involves very little blood loss. Swelling can occur following this surgery, but is usually minor.
This type of surgery can result in bone thickening where the bone was cut, and is prone to a higher rate of recurrence than traditional surgical techniques. A new variation on this procedure attempts to prevent craniosynostosis from recurring by placing springs in the re-opened fissures. These springs need to be removed in a second surgery, when your doctor believes your child is ready.
A cranial helmet is required after this type of surgery, and your doctor will discuss the frequency of re-fittings and follow-up visits that your child needs, based on their particular case. Generally, your child will need to see his or her specialist at least once every three months for the first year following the surgery.
The number of sutures initially involved in the craniosynostosis, the complexity of the surgery (if applicable), your child’s health prior to the procedure, and the presence of any atrophies in the brain all affect the post-operation outcome for your baby. Unless your child is suffering from syndromic craniosynostosis however, the prognosis following surgery is usually good.
Genetic counseling may be recommended, in order to make sure that your child is not suffering from a hereditary disorder. Frequent well-child visits will be necessary to monitor the growth of your child’s brain, skull and facial bones in order to make sure that they are growing normally following the procedure. Craniosynostosis can re-occur in some cases.
Additionally, reconstructive surgeries that repair facial deformities may be necessary or cosmetically recommended based on the factors surrounding your baby’s particular case.