Craniosynostosis

Diagnosis

Craniosynostosis is usually diagnosed by specialists such as pediatric neurosurgeons or plastic and reconstructive surgery experts. The diagnosis may include the following steps:

• Physical Exam:
  The healthcare professional examines your baby’s head to feel for suture ridges and observe any abnormal facial or skull shape.

• Imaging Studies:
  Tests like CT scan and MRI provide detailed images of your baby’s skull. These show whether any sutures have fused prematurely.

  • Cranial ultrasound may also be used.

  • If sutures are not visible, it means they are closed.

  • Laser scans and photographs help in making precise skull measurements for diagnosis and surgical planning.

• Genetic Testing:
  When a genetic syndrome is suspected, genetic testing can help identify the specific condition associated with craniosynostosis.

• Prenatal Detection (Rare):
  In some cases, craniosynostosis can be suspected or diagnosed before birth using advanced imaging.

Treatment

Treatment for craniosynostosis depends on the type, severity, and whether it’s syndromic (linked to genetic conditions). A multidisciplinary team of specialists is typically involved in your child’s care.

• Mild Cases:
  Mild craniosynostosis may not require surgery and can be managed with observation and follow-up.

• Surgical Treatment:
  For most babies, surgery is the main treatment. The goal is to reshape the skull, reduce or prevent brain pressure, and allow normal brain growth.

Surgical Planning

Before surgery, 3D CT and MRI scans are used for virtual surgical planning. Surgeons use these images to create a computer-simulated surgical plan, along with customized models and templates that guide the operation with precision.

Surgery Options

Craniosynostosis surgery is performed by a team including a craniofacial surgeon and a neurosurgeon. Two main surgical approaches are used:

• Endoscopic Surgery:

  • Best for babies younger than 6 months.

  • Minimally invasive, using small scalp incisions and an endoscope (a thin tube with a camera).

  • The closed suture is removed to allow skull expansion.

  • Involves smaller incisions, shorter hospital stays, and less blood loss.

  • Typically, only a one-night hospital stay is needed.

• Open Surgery:

  • Usually performed for babies older than 6 months.

  • Involves reshaping the skull bones after opening the scalp and cranial areas.

  • Plates and screws (which dissolve over time) hold the bones in place.

  • Requires a 3–4 day hospital stay and often blood transfusion.

  • Generally, it’s a one-time procedure, though complex cases may require additional surgeries.

Spring-Mediated Cranioplasty

In some cases, metal springs are used to expand the skull space after suture removal. This can be done during either open or endoscopic surgery.
A second procedure is needed to remove the springs later.

Helmet Therapy

After minimally invasive surgery, your baby may need helmet therapy to gently guide skull shaping:

• Helmets are custom-fitted during regular visits.

• Usually worn 23 hours a day for about a year.

• The duration depends on how quickly the skull reshapes.

• Open surgery patients typically do not require helmet therapy.