What words should I know about craniosynostosis surgery?

Cerebral spinal fluid (CSF)

Is a clear fluid that is produced and absorbed by the brain and serves to cushion and protect the brain and spinal cord.

Computerized tomography (CT) scan

CT scans are a type of medical imaging which uses x-rays to visualize the bones of the skull. A CT scan may be ordered to confirm the diagnosis of craniosynostosis which will show a fusion of the involved suture.

Craniosynostosis

A condition in which one or more of the growth plates of the skull (sutures) fuses prematurely resulting in in problems with brain and skull growth. Premature closure of a suture can result in increased pressure in the head which is why surgical release of these sutures is indicated to allow space for ongoing brain growth and development.

Increased intracranial pressure (ICP)

Intracranial pressure is the pressure inside the skull and is therefore the pressure exerted on the brain and the surrounding cerebrospinal fluid which cushions the brain. In craniosynostosis the fused suture restricts normal skull growth and can lead to elevated pressures which is detrimental to brain development.

Open cranial vault remodeling

Is a surgery that is performed through curved or "zig-zag" incision that extends over the top of the head from ear to ear. Through this incision the fused suture and is exposed and surgically released by making a cut through the bone. Typically, additional cuts are made in the adjacent bones expand the skull and correct the abnormal skull growth that has occurred. The cut bones are then bent, rotated or repositioned to create a more symmetric head shape. The bones are then held in place with a combination of absorbable plates, metal wires or suture.

Papilledema

Is a sign of elevated intracranial pressure which can be detected during an eye examination. Papilledema is a swelling of the optic nerve which can be seen inside the eye using specialized instruments. Screening for papilledema is a way that your craniofacial team will monitor your child for elevated intracranial pressure both before and after craniosynostosis surgery.

Positional plagiocephaly

A flattening or molding of the head related to external pressure from a child preferentially lying on one side of their head. In positional plagiocephaly all the sutures of the skull are normal, and the molding is not related to a premature fusion of a suture. Positional plagiocephaly can be diagnosed by your craniofacial surgeon and can be treated with repositioning of your child while sleeping. Tightness of the neck muscles (torticollis) may also predispose your child to turning their head to one side. Positional plagiocephaly does not require surgery but in some cases may require custom helmet therapy to help mold the head into a more typical shape.

Spring-assisted strip craniectomy

Is very similar to a regular strip craniectomy surgery but differs in the placement of a spring along the cut bone edges which helps to hold open the released suture. The spring will need to be removed surgically after it has exerted its effect. It is possible that helmet therapy may still be required after removal of the spring.

Strip craniectomy surgery

Is a more limited surgery than an open cranial vault remodeling. With strip craniectomy surgery smaller incisions are made in the scalp directly overlying the fused suture. Through these limited incisions the fused suture is released by making cuts in the bone directly adjacent to the suture. Sometimes a special camera (endoscope) is used to help visualize the cuts in the bone through the smaller incisions. Following this surgery, a custom helmet is required to help gradually mold the skull into a more symmetric and round shape. The helmet will be adjusted by an orthotist who specializes in creating custom helmets for the treatment of craniosynostosis.