Craniosynostosis Surgery: Overview

By Cristiano Antonino On Jul 8, 2022

The recommended treatment for most cases of craniosynostosis is surgery. During the procedure, the surgeon moves your child’s bony plates in the skull into a more circular shape

The two goals of craniosynostosis surgery are to correct your baby’s head shape and to provide sufficient room for their brain to grow normally.

In this article, we’ll discuss the two types of craniosynostosis surgery and how to determine which one is right for your child.

What Is Craniosynostosis Surgery?

Craniosynostosis surgery is an inpatient procedure that may require several days in the hospital for recovery.

After your child is discharged from the hospital, their medical team will continue to monitor your baby’s head shape through follow-up appointments.

Craniosynostosis surgery is recommended during an infant’s first year of life

This is because the bony plates are still soft and flexible enough to be moved.2

The two types of craniosynostosis surgery are calvarial vault remodeling and endoscopic surgery.

The two surgeries use different techniques to reshape a baby’s skull.

Calvarial Vault Remodeling

Calvarial vault remodeling is an open surgery in which the surgeon makes an incision in the infant’s scalp.

The surgeon then moves the bony plates of the skull into a circular shape.

This surgery may take up to six hours and usually requires a blood transfusion due to blood loss during surgery.3

Once the surgeon has completed the operation, your baby will most likely spend one night in the intensive care unit for close monitoring.

Most children are then moved to a regular hospital room one day after surgery.

Calvarial vault remodeling is usually recommended for infants 6 months old and older.

This is because their bony plates are flexible enough to be moved but thick enough to hold their new shape.3

Endoscopic Craniosynostosis Surgery

Endoscopic craniosynostosis surgery is a less invasive option for treating craniosynostosis.

During the procedure, the surgeon makes several tiny incisions in the scalp and then uses a small tube called an endoscope to move the infant’s bony plates into a circular shape.

Endoscopic surgery is usually recommended for infants between 2 and 4 months of age.

This is because their bony plates are soft and flexible enough to be moved with an endoscope.4

Endoscopic surgery for craniosynostosis usually takes one hour to perform and is much less likely to require a blood transfusion

After surgery, your child will likely need to spend one night in the hospital before being discharged home.

Because a young infant’s skull bones are still growing quickly, your child will need to wear a molding helmet after endoscopic surgery.

This helps to ensure that their skull continues to keep its circular shape.

Potential Risks

As with any surgery, there are risks associated with craniosynostosis surgery.

In addition to the usual surgery risks like infection and an adverse reaction to anesthesia,6 craniosynostosis surgery may lead to:5

Blood loss: A 2016 study found that 5% of patients who underwent endoscopic craniosynostosis surgery required a blood transfusion during surgery, and 5% received a transfusion after surgery. Of the patients who underwent calvarial vault remodeling surgery, 96% received a blood transfusion during surgery and 39% required one after surgery.
Readmission: The same study found that 1.4% of craniosynostosis surgical patients needed to be readmitted to the hospital following discharge.

Purpose of Craniosynostosis Surgery

The purpose of craniosynostosis surgery is to correct the shape of the skull while relieving any pressure on the brain.

When a suture closes and the skull bones join together too soon in that area, the baby’s head will stop growing in only that part of the skull.

In the other parts of the skull, where the sutures have not joined together, the baby’s head will continue to grow.

When this happens, the skull will have an abnormal shape.1

Sometimes more than one suture closes too early.

In these instances, the brain may not have enough room to grow to its usual size.

Without treatment, the brain may continue to grow in a confined space, leading to increased intracranial pressure.7

How to Prepare

Prior to surgery, you and your child will meet with the surgical team to discuss the procedure and what to expect.

This is an excellent time to ask questions.

It can be difficult to remember all of your questions during a short appointment, so consider writing them down ahead of time and bringing a list with you.

What to Expect on the Day of Surgery

Depending on which type of surgery your child is undergoing, expect the procedure to take anywhere from one to six hours to complete.

Once surgery is finished, your child will be taken to the post-anesthesia care unit, where they will be closely monitored.3

A nurse will come to find you in the waiting room to let you know when you can be with your baby.

Recovery

After craniosynostosis surgery, your child will seem tired and groggy from the anesthesia.

It is normal for their face to look swollen too.

Their head will be wrapped in bandages.

If your child lost blood during surgery, they may need a blood transfusion.

After the medical team has determined that your baby is stable after surgery, your baby will be moved to a hospital room.

Here, the team will monitor the child for signs of complications, such as a fever, vomiting, decreased alertness, or irritability.

The nurses will check your child’s incision to make sure there are no signs of infection.

Possible signs of infection include redness, swelling, and pus.3

Long-Term Care

Once discharged home from the hospital, your child will have several follow-up appointments.

During these appointments, the surgeon will examine their head shape, measure their head circumference, and monitor for any complications.

Follow-up appointments for calvarial vault remodeling are usually scheduled for one month, six months, and 12 months after the surgery.

Follow-up appointments for endoscopic craniosynostosis surgery are usually scheduled for three, six, nine, and 12 months after surgery.3

If your baby underwent endoscopic craniosynostosis surgery, your child will need to wear a cranial orthotic helmet for a period of time.

This helps to mold the head into a normal shape as it continues to grow.3

They will also have follow-up appointments with a helmet specialist to monitor their head growth and make changes as necessary.8

References:

Centers for Disease Control and Prevention. Facts about craniosynostosis.
Proctor MR. Endoscopic craniosynostosis repair. Transl Pediatr. 2014 Jul;3(3):247-58. doi:10.3978/j.issn.2224-4336.2014.07.03
John Hopkins Medicine. Craniosynostosis.
Garrocho-Rangel A, Manriquez-Olmos L, Flores-Velazquez J, Rosales-Berber MA, Martinez-Rider R, Pozos-Guillen A. Non-syndromic craniosynostosis in children: Scoping review. Med Oral Patol Oral Cir Bucal. 2018 Jul 1;23(4):e421-e428. doi:10.4317/medoral.22328
Han RH, Nguyen DC, Bruck BS, Skolnick GB, Yarbrough CK, Naidoo SD, Patel KB, Kane AA, Woo AS, Smyth MD. Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution. J Neurosurg Pediatr. 2016 Mar;17(3):361-70. doi:10.3171/2015.7.PEDS15187
UCLA Health. Craniosynostosis.
Kajdic N, Spazzapan P, Velnar T. Craniosynostosis – Recognition, clinical characteristics, and treatment. Bosn J Basic Med Sci. 2018 May 20;18(2):110-116. doi:10.17305/bjbms.2017.2083
Nationwide Children’s. Craniosynostosis: Causes, symptoms, diagnosis and treatment.
Zubovic E, Lapidus JB, Skolnick GB, Naidoo SD, Smyth MD, Patel KB. Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques. J Neurosurg Pediatr. 2020 Jan 10:1-10. doi:10.3171/2019.11.PEDS19515