from staff
Craniosynostosis is a congenital (present at birth) defect that causes one or more sutures on a baby’s head to close earlier than normal. Sutures are connections that separate each individual’s skull bones. The early closing of a suture leads to an abnormally shaped head and can affect the eye sockets by pushing them toward the back of the head. The condition also can lead to pressure on the brain and affect brain development.
Normally, the condition is corrected before the age of 1 with an ear-to-ear incision on top of the head to “peel” back the forehead to expose the skull, open the suture(s) and move the eye sockets forward. This surgery, while usually successful, results in significant blood loss and transfusions, a lengthy stay in the hospital, and a very large scar that, while covered by hair, may still be visible.
Pediatric neurosurgeon Dr. Ian Heger, along with pediatric craniofacial surgeon Dr. Eric Stelmicki, his former colleague at Joe DiMaggio Children’s Hospital in Hollywood, Fla. developed a minimally invasive technique for the procedure. Heger, now an assistant professor of Neurosurgery at the University of Florida College of Medicine in Jacksonville, will perform the novel procedure at Wolfson Children’s Hospital for the first time Thursday on a 4 month-old baby girl with craniosynostosis. He will be assisted by Nemours Children’s Clinic pediatric craniofacial surgeon Dr. Saswata Roy and Dr. Stelmicki, who is flying up to Jacksonville for the procedure.
With minimally invasive endoscopic-assisted cranial vault reconstruction surgery, the pediatric neurosurgeon makes two small incisions on top of the head and inserts one endoscope with a tiny camera and another that contains a tiny cutting tool. This tool allows the physician to cut open the fused suture(s) in the skull from underneath the skin, as well as cut out a strip of bone over the orbital rim (eye ridge) to move the bone forward. Plates are placed where the bone was removed and later dissolve as the child’s skull develops and fills in the gap. The two-hour procedure causes minimal blood loss compared to the open procedure, along with a two- to three-day hospital stay. The tiny incisions make almost invisible scars that are covered as the baby’s hair grows.
“In the open procedure, surgeons wait until the child is at least six months old when the bone is stronger and less malleable since you have to cut the forehead out and slide it forward,” explains Dr. Heger. “In the minimally invasive procedure, it is advantageous for the bone to be softer.”
Following surgery using either technique, children wear molding helmets to help reshape the head. The helmet must be worn 23 hours a day for anywhere from two weeks to six months and is only taken off at bath time.
“As we progress in this minimally invasive procedure, we may not need to use molding helmets on all post-surgical patients,” said Heger. “We are trying to determine which children will require a helmet following surgery and which won’t.”
Roy is optimistic about how the procedure will benefit children with craniosynostosis in the region. “We are now providing a minimally invasive option that will allow children to avoid undergoing the more invasive procedure that has been done in the past,” said Roy. “This is really cutting edge and the next generation of treatment for this condition. We are using similar endoscopic technology to perform other minimally invasive skull base surgeries at Wolfson Children’s Hospital.”