Craniosynostosis is a rare disorder in which bones of an infant’s skull join together prematurely. If left untreated, it may put pressure on the child’s brain as it grows, squeezing it, and will likely cause his or her head to be misshapen.
The traditional surgery to relieve craniosynostosis requires several hours of “open” cranial vault surgery in order to resect and reshape the bones of the skull. This procedure most often requires a blood transfusion and risks severe complications. With that said, craniofacial surgeons have been performing it for years with excellent results.
Today, however, skilled surgeons like Dr. Hugo St. Hilaire are able to offer parents an alternative. Developed over the past 15 years or so, camera-assisted techniques (known collectively as endoscopy) have given doctors a range of minimally-invasive options when treating craniosynostosis in infants.
Endoscopic Cranial Vault Surgery
A minimally-invasive procedure, known as endoscopic cranial vault remodeling takes advantage of the rapid growth of the brain within the first two years of a child’s life to correct a rare condition known as craniosynostosis.
A tiny camera inserted through a small incision provides the surgeon with an excellent view of the structures beneath the skin, and state-of-the-art instrumentation enables his work. In this way, we avoid injury to the dura (the membrane that protects the infant’s brain) and operate in an extremely stable environment.
Early intervention is the key—surgery must be performed in the first six months of life—because in the first few months the deformity is not as severe and bones of the skull are much more responsive to treatment. After six months of age, NOLA Craniofacial recommends open vault surgery, as performed by a skilled craniofacial surgeon.
Craniosynostosis, as noted above, involves the premature “ossifying” of the sutures—or joints—that allow the skull to expand to accommodate the rapid early development of a baby’s brain. If the condition is identified in those first six months, endoscopic surgery allows the surgeon to remove the affected suture (or sutures) through only the smallest of incisions.
Thereafter, the child will need to wear a specially-made helmet for up to two years in order to guide the continued growth of the brain and its calvarium (skull).
Allowing the Body to Heal Itself
There are distinct advantages to endoscopic intervention, as opposed to traditional cranial vault surgery.
First and foremost among these is a dramatically reduced risk of complications. Traditional cranial vault surgery almost always requires a major blood transfusion, whereas in most cases major bleeding can be avoided with endoscopy. If a transfusion is required, the requirements usually minimal.
At NOLA Craniofacial, we prepare for every eventuality by securing direct donations from the parents and/or family of matching blood type.
In addition to a reduced stay in the hospital, endoscopic cranial vault modelling allows the child’s body to manage its own recovery. As is normal, the growth of the child’s brain—and not the surgeon—determines the shape of the skull.
Helmet Therapy Following Endoscopy
Helmet therapy is required for 12 to 14 months following endoscopic cranial vault modelling. Indeed, requisite follow-up care is absolutely essential to achieving a successful result.
These helmets are specially-made to fit each patient infant’s head. A painless process involving a laser surface scan of the scalp provides data to the manufacturer. Once the helmet is received and fitted, monthly adjustments are overseen by a licensed therapist.