Craniosynostosis

What is craniosynostosis surgery?

Before birth, the babies skull is made is made of several bones connected by joints called sutures. Craniosynostosis is a condition in which these joints between the skull bones fuse too early. If this occurs (usually before birth) it can cause an abnormal head shape, or in some cases restrict growth of the brain, which increases the pressure inside the skull.

Surgery for craniosynostosis is designed to correct the abnormal head shape and allow the growing brain room to expand normally.

The surgery for craniosynostosis is typically performed in the first year or so of life. There are multiple types of surgery used to treat craniosynostosis, including strip craniectomy, spring-assisted craniectomy and cranial vault remodelling. Not all patients are a candidate for all types of surgery.

There are 2 centres in New Zealand performing this surgery, one in Auckland and one in Wellington with regular clinic in Hawkes Bay, Christchurch and Dunedin. The surgery is performed by a team of a Plastic Surgeon, a Neurosurgeon and a Paediatric Anaesthetist working together.

Plastic Surgeons in New Zealand who do Craniofacial Surgery have undergone additional specialist training in international centres doing this surgery.

Craniosynostosis surgery aims to address:

• Abnormal skull shapes that result from early suture fusion
• Raised intracranial pressure (ICP), or pressure on the brain caused by restriction of skull growth
• Certain problems with eye position related to suture fusion

Your Plastic Surgeon/ Craniofacial Surgeon will examine your child, determine if craniosynostosis is likely and discuss what types of surgical procedures are options for your child. In some cases, additional imaging, such as a CT scan, might be needed to help with diagnosis or to plan surgery.

The Craniofacial team will make a recommendation about the most appropriate form of treatment. In some cases this may be surgery and in other cases it may include monitoring over time. If surgery is recommended, the surgical team will discuss the rational for this and also the expected procedure and hospital stay. They will also discuss the potential risks and complications of surgery.

The decision to have surgery in infants is usually made in order to protect the growing brain and give it room to enlarge without being compressed. It may also include protection of the eyes and improvement of breathing. There may be improvements in general appearance as well.

You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications. It is also important to consider the complications that may occur if no treatment is performed.

The risks will be fully discussed prior to your consent. It is important that you address all your questions directly with your surgeon.

What should I expect during a consultation for craniosynostosis surgery?

During your craniosynostosis surgery consultation be prepared to discuss:

Your child’s growth and development

• Any changes you have noticed to your child’s head shape or eye position
• Any other medical problems your child has
• Previous surgeries or hospitalizations

Your plastic surgeon will also:

• Evaluate your child’s head shape
• Arrange for medical photographs
• Discuss your craniosynostosis surgery options
• Recommend a course of treatment
• Discuss likely outcomes of craniosynostosis surgery and any potential risks
• Discuss the planned hospital stay, including potential blood transfusions and intensive care unit (ICU) stay

In preparing for craniosynostosis surgery, your child may be asked to:

• Have a blood test
• Have xrays such as a CT scan
• Meet with a multidisciplinary team of several medical specialists who will help to coordinate all of your child’s care

The consultation is the time to ask your plastic surgeon questions. Craniosynostosis is a complicated problem and may raise many questions or concerns for you. Don’t hesitate to discuss these concerns with your plastic surgeon.