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>> My name is Rick Redett,
and I'm a pediatric plastic surgeon who specializes
in caring for kids with cleft lip and palate
and craniofacial differences.
Cranial anomalies in kids are
generally due to trauma to the head,
fractures of the bones that make up the skull,
or sometimes even when a piece of bone
needs to be removed to operate on the brain.
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>> Hi, my name is Eric Jackson.
I'm a pediatric neurosurgeon at Johns Hopkins.
The primary process of evaluation
starts with a physical examination
with us looking and trying to determine
what is the actual anomaly that we're trying to treat.
Often, based on that, we will recommend
some sort of imaging study
and we have worked a lot with our radiologist
to try to get the studies down
to reduce the amount of anesthesia
or radiation needed through low dose protocol CT scans,
or through limited MRI scans
that avoid the need for anesthesia.
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So I think there's three main reasons
why we would do surgery for a cranial anomaly.
The first would be for diagnosis.
If there's a lesion in the head or skull
that we're not sure what it is,
then oftentimes we like to get tissue
to figure that out to know if
there's any other treatment that would be needed.
The second is for brain protection.
Oftentimes if there are defects in the skull
or the tissue around that, then the brain can be at risk.
So, obviously, we would want to fix that
in order to protect the brain itself.
And then lastly is, obviously, if there is
any significant cosmetic deformity
that's noticeable both to the patient and the family,
those would be the main reasons
we would consider intervention.
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The surgical treatment for cranial anomalies
is gonna depend on the anomaly itself.
For instance, if it's a bony defect,
then the surgery is primarily
going to be the reconstruction.
If there is an abnormality
or a lesion that we have to remove,
then the surgery will entail both
the removal and the reconstruction
which is typically done in the same setting.
For the reconstruction, decisions are made
on a patient-specific basis due to a variety of options.
For a very small defect, for instance in an infant
that's often growing bone very rapidly,
we may actually leave it open
and allow them to heal it on their own.
For larger defects, we tend to do one of two options.
One is using the patient's own bone,
usually through what are called split-thickness grafts,
where we take their bone, split it in half,
and then put half where we took it from
and then the other half to fill the defect.
The other option is to use synthetic cranial implants
that are made based on 3D imaging.
For either of these options, we have the option
of using permanent plates versus resorbable plates
that will go away and dissolve over time
which tends to be a better option for our younger patients.
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>> Multidisciplinary care is a groups of specialists
that have different but complementary skills,
knowledge and expertise and allows us as a team
to really provide the best care possible for your child.
The specialists on our team include a radiologist,
a neurosurgeon, a pediatric plastic surgeon
and a craniofacial surgeon.
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State of the art patient care is the focus
of everything we do at the Children's Center.
Our team of specialists really remains
on the leading edge of not only patient care
but also research into treating
children with cranial anomalies.
We have kids that come from all over the world,
the Middle East, Africa, South America and Europe
to receive very specialized cranial care.
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(people chattering) (children laughing)