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Craniosynostosis repair

Craniectomy - child; Synostectomy; Strip craniectomy; Endoscopy-assisted craniectomy; Sagittal craniectomy; Frontal-orbital advancement; FOA

Craniosynostosis repair is surgery to correct a problem that causes the bones of a child's skull to grow together (fuse) too early.

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Description

This surgery is done in the operating room under general anesthesia. This means your child will be asleep and will not feel pain. Some or all of the hair will be shaved.

The standard surgery is called open repair. It includes these steps:

Surgery usually takes 3 to 7 hours. Your child will probably need to have a blood transfusion during or after surgery to replace blood that is lost during the surgery.

A newer kind of surgery is used for some children. This type is usually done for children younger than 3 to 6 months old.

Children do best when they have this surgery when they are 3 months old. The surgery should be done before the child is 6 months old.

Why the Procedure Is Performed

A baby's head, or skull, is made up of eight different bones. The connections between these bones are called sutures. When a baby is born, it is normal for these sutures to be open a little. As long as the sutures are open, the baby's skull and brain can grow.

Craniosynostosis is a condition that causes one or more of the baby's sutures to close too early. This can cause the shape of your baby's head to be different than normal. It can sometimes limit how much the brain can grow.

An x-ray or computed tomography (CT) scan can be used to diagnose craniosynostosis. Surgery is usually needed to correct it.

Surgery frees the sutures that are fused. It also reshapes the brow, eye sockets, and skull as needed. The goals of surgery are:

Risks

Risks for any surgery are:

Risks for this surgery are:

Before the Procedure

If the surgery is planned, you will need to take the following steps:

During the days before the surgery:

On the day of the surgery:

Ask your provider if your child can eat or drink before surgery. In general:

Your doctor may ask you to wash your child with a special soap on the morning of the surgery. Rinse your child well.

After the Procedure

After surgery, your child will be taken to an intensive care unit (ICU). Your child will be moved to a regular hospital room after a day or two. Your child will stay in the hospital for 3 to 7 days.

Talking, singing, playing music, and telling stories may help soothe your child. Acetaminophen (Tylenol) is used for pain. Your doctor can prescribe other pain medicines if your child needs them.

Most children who have endoscopic surgery can go home after staying in the hospital one night.

Follow the instructions given to you on caring for your child at home.

Outlook (Prognosis)

Most of the time, the outcome from craniosynostosis repair is good.

Related Information

Craniosynostosis
Bringing your child to visit a very ill sibling
Preventing head injuries in children

References

Demke JC, Tatum SA. Craniofacial surgery for congenital and acquired deformities. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 187.

Gabrick KS, Wu RT, Singh A, Persing JA, Alperovich M. Radiographic severity of metopic craniosynostosis correlates with long-term neurocognitive outcomes. Plast Reconstr Surg. 2020;145(5):1241-1248. PMID: 32332546 pubmed.ncbi.nlm.nih.gov/32332546/.

Lin KY, Persing JA, Jane JA, and Jane JA. Nonsyndromic craniosynostosis: introduction and single-suture synostosis. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 193.

Proctor MR. Endoscopic craniosynostosis repair. Transl Pediatr. 2014;3(3):247-258. PMID: 26835342 pubmed.ncbi.nlm.nih.gov/26835342/.

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Review Date: 10/12/2020  

Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Surgery, Johnson City Medical Center and Holston Valley Medical Center, TN; Department of Surgery St-Alexius Medical Center, Bismarck, ND; Department of Neurosurgery Fort Sanders Medical Center, Knoxville, TN, Department of Neurosurgery UPMC Williamsport PA, Department of Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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