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>> Craniosynostosis is when the sutures of the skull
close early which causes the bones to fuse.
So our skull is made up of multiple bones
that have these sutures running between them
that allows the skull to grow
to allow the brain to grow.
When the sutures fuse,
what happens is that it restricts the growth of the skull
which then restricts the growth of the brain.
There are multiple different types of synostosis
with four sutures that are the main ones we think about.
The first one and the most common is sagittal synostosis.
Sagittal synostosis is when the sagittal suture
which runs right here closes.
This causes a very long and narrow head.
Other suture that commonly confuse are the metopic suture
which is the suture that runs in the forehead here.
The interesting thing about the metopic suture
is that it's the only one of the major sutures
that is normal to close in the first year of life.
So with that, we will often see patients
who will have a ridge in that region
but the forehead is not shaped like a triangle.
In those cases where the forehead is round,
we typically do not recommend treatment.
Treatment is reserved for the patients,
what's called trigonocephaly,
where the forehead really resembles a triangle
and the brain growth is restricted.
The other common synostosis
is what's called coronal synostosis.
And the coronal sutures run from here across the top
and there's actually two of them.
So either suture can fuse or both can fuse.
If one fuses then typically the face is misshapen
and the nose and chin point away
and the eye on that side is actually affected as well.
Lambdoid synostosis is the least common and is fairly rare.
In all, about one in 2,000 live births has craniosynostosis,
so it is fairly common in the population
and something that is regularly dealt with.
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Craniosynostosis is diagnosed first by either the parents
or pediatrician noting an abnormal head shape.
As mentioned earlier,
the head shape for synostosis are fairly characteristic
based on the suture that's fused.
One important distinction is determining craniosynostosis
versus positional plagiocephaly
which is where the head gets misshapen from laying on it
rather than the bone being fused.
Now that's something where there is a very normal appearance
for each of these things
so someone with experience is usually very able
to distinguish these.
Sometimes in specific cases it may require imaging
to determine what is fused
and if there are things that would require intervention.
But in most cases,
we can at least make a preliminary diagnosis
solely based on the clinical examination.
Typically, we like to see these patients
as early as possible
because there are different treatments that we can offer
in younger children that cannot be done once they're older.
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Treatment of craniosynostosis is typically surgical
and there are a number of different options
for how it can be treated.
There are the lesser invasive options
which are typically done less than three months of age
and the more classic open surgeries
that are done when the child is older.
For the less invasive options,
typically we use an endoscope to assist
and the goal of this surgery
is primarily to remove the involved suture.
So we make small incisions
and then separate the bone from the covering of the brain
and cut the bone out.
The patient then is followed in the hospital overnight
and typically goes home the next day.
Then something needs to be done over time
to help reshape the head.
In most cases this is a helmet,
but in certain instances you can also do springs
which prevent you from needing to go for helmet appointments
but does require an additional surgery to remove them.
If the child is older,
then typically it's an open remodeling
where it's a larger incision and we remove all of the bone
and then reshape it and replace it
and this is typically done with a plastic surgeon as well.
So after the more minimally invasive operations,
the children are typically watched overnight
and often go home the next day.
They tend to return to normal activity fairly quickly.
With the more open procedure,
they're typically in the hospital a little bit longer
but usually in followup
have also returned to normal fairly quickly.
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So the typical followup care
obviously depends on which operation was done.
For the less invasive procedures,
typically the patients leave the hospital the next day.
We would tend to see them back in about a month
to make sure everything is healing appropriately
and then usually every three months for the first year.
If they have a helmet,
then they are seeing the orthotist fairly regularly
for refitting and adjusting their helmet as well.
Once they're beyond that point of a year,
typically the followup spaces out,
although we will continue to follow them
as this is something that can recur so we follow them
at least until they're about six years of age
to ensure they don't develop any problems later.
For the most part, most of the patients do very well
and don't have problems in the long term.
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With our craniofacial clinic
and pediatric cranial reconstruction center,
we provide truly multidisciplinary care.
We work with specialists from a number of departments
across the institution
to ensure that each step is appropriate,
from diagnosis including limiting the amount of radiation
that may be required to make the diagnosis
to offering all the different possible treatment options
and then providing exceptional care
by our nurses and operating room staff
to keep the patient well after the surgery
or treatment has been completed.
As there are multiple treatment options
for craniosynostosis, we work with patients and families
to determine the best possible treatment option
to help them make the right decision for their family.
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