The first surgical treatment of craniosynostosis was undertaken by Lannelongue in 1892, and involved the correction of a sagittal synostosis. Since then, multiple procedures have been used for the treatment of this condition, ranging from simple suturectomies(removal of fused sutures without skull remodeling to extensive cranial vault reconstruction. The type of surgery done for craniosynostosis is unique to the surgeon performing the repair and unique to the which suture is fused. I encourage parents to thoroughly research all their options before deciding which surgery is best for your child. Second and third opinions from different craniofacial surgeons is recommended if you are unsure of the first consult.
The pro's of the endoscopic surgery are:
- Decreased operative time (1.5 hours or less vs. usually 5 or more hours)
- There is usually no need for a blood transfusion, and much decreased blood loss
- No plates or screws are needed
- Shortened hospital stay: patients generally go home on day 1 or day 2
- Smaller incisions which have significantly reduced scars
- Greatly reduced discomfort and swelling.
- Craniosynostosis must be caught at an early age for the best cosmetic results.
- travel to a qualified surgeon(few surgeons are qualified to perform the endoscopic procedure)
- a year of helmet wearing which will also require possible traveling for adjustments and checkups as the child grows out of the helmet.
- less favorable cosmetic results
- a higher possibility of secondary surgery later
- possibility of missed hydrocephelous when no CT scans are performed prior to surgery(it is stated that CT scans are not ordered in Saggital cases)
- Hyperostotic bone(Excessive or abnormal thickening or growth of bone tissue)
- leptomeningeal cyst which can develop if a dural laceration is not seen and repaired during surgery
- if a complication with bleeding should arise during surgery precious time is lost due to needing to open up the skull for repair.
An incision is made in the scalp from ear to ear in either a zig-zag pattern or u-shape. The skull bones are then cut and removed by a pediatric neurosurgeon. A CVR should never be performed without the neurosurgeon who's job is to protect the duram that surrounds and protects the brain. A pediatric craniofacial surgeon then will reconstruct and piece the skull bones back together using plates, screws, and stitches. Most of these foreign objects are absorbable which means as the new bone grows the plates and screws will slowly disappear.
The pro's of CVR Surgery are:
- Immediate and often lasting correction of the deformity without any visible or palpable bony defects
- Drastically reduced occurrences of secondary surgeries
- More qualified surgeons available to perform CVR surgery
- CVR is most successful when performed on children younger than one year of age but is highly successful when performed on even older children
- Any complications with the duram or blood loss can be immediately handled.
- Most successful treatment for multi-suture synostosis and severe cranial deformity.
- Blood loss with the need of blood transfusions(although this risk can be greatly reduced with the use of procreate shots and blood recycling procedures.)
- Highly invasive surgery that last 5 to 9 hours typically
- Plates and screws most often are needed
- 48 hour stay in PICU required followed by 3 or 4 more days in hospital
- Swelling and bruising
Barrell Stave Craniectomy:
Jorge Posada Foundation
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