Craniosynostosis and its treatment | Boston Children’s Hospital

Hi, I’m Dr. John Meara and I’m the Plastic
Surgeon in Chief at Boston Children’s Hospital. And I’m Dr. Mark Proctor, the Neurosurgeon
in Chief here at Boston Children’s Hospital. And we’re here today to talk to you
about a condition called craniosynotosis. Normally when a child is born, there
are a number of bones in the head, and these are separated by what’s
called a suture, these small lines here. This allows for growth of the brain and the skull. Now when one of these sutures is
closed, that’s called craniosynostosis, and about 1 in 2,000 children have this condition. It can be scary to hear that your child
has a problem with the skull or brain, and in fact craniosynostosis can be a serious condition, but it’s important to know that at Boston Children’s Hospital we have all the resources that you’ll need. We have put together a world-class team of experts
to treat your child’s condition of craniosynostosis. We will be with you at every step of the way
to treat the physical, emotional and social needs of you and your family, and involve
the family at every step of the treatment. The most common form of
synostosis is sagittal synostosis, when the two bones here on the top of the
head are fused together at the sagittal suture. This leads to an elongation and narrowness of the skull. Another form of craniosynostosis is coronal synostosis. This can affect either one or both of the coronal sutures, in this case of right coronal synostosis. We can see how the forehead
gets flattened on that side, and in addition, the nose tilts over
towards the affected side of the head. This occurs in about 15% of babies with synostosis. Now if both of those sutures are fused, you can see across the top here – both coronal sutures are fused. This does not allow either frontal
bone to grow forward as it should, and you can see that the head is
much shorter from front to back, this is called brachycephaly. Metopic synostosis, or premature fusion
of the two bones in the front of the head, occurs in about 15% of babies with synostosis. Some children simply have a ridge over that suture, and that is not necessarily a surgical problem. But when you get a triangular
shape to the front of the head, often an operation is necessary. By far the least common form of
craniosynostosis is lambdoid synostosis. This occurs when one of the sutures in
the back of the head fuses together early. We want to stress that almost every child we
see that has flattening of the back of the head, actually has a normal skull and has just
been sleeping on that side of the skull. Lambdoid synostosis is seen in about
one in every hundred cases of synostosis. Depending on the age of your child
and the nature of the suture fused, there are a number of different treatment
options for children with craniosynostosis. For most babies diagnosed with craniosynostosis, surgery is going to be the primary treatment option. There are really two goals to the operation. One is to allow for a more normal appearance, and the other is to allow for normal
brain growth and development. For some of the rare or complex craniosynostoses, working with our simulation center, we have the ability to make an
individualized model of your child’s skull, so that we can practice the procedure
before going to the operating room. If your child is under three to six months, there may be a minimally invasive endoscopic operation for the treatment of that synostosis. In this model of sagittal synostosis, that
treatment will involve two small incisions, one up near the front of the head
and one near the back of the head, and then an actual removal
of the fused part of the bone. If your child is older than five or six months of age, or for the more severe forms of craniosynostosis, another procedure is often utilized. This is called a frontal orbital advancement. I usually start the procedure by
making an incision from ear to ear, and then dissecting down towards the eyes. I would then remove the frontal bones, and then Dr. Meara and I would then work together to remove the bones just above the eyes. Now, once we’ve removed these bones, I work to put these back in place. So this part of the bone that’s
above the eyes comes forward, usually about ten millimeters. and the frontal bones also come forward to meet that. After that, we plate these with special
resorbable plates that don’t stay forever. And then Dr. Proctor and I will close the incision, and we’ll usually put one small drain
that comes out through the scalp, and then wrap the head with a clean, white dressing. All of us at Boston Children’s Hospital
believe in patient and family-centered care. That means that all of our medical and nursing professionals are here for you and your child, and will be with you throughout
your entire treatment course. US News and World Report consistently
ranks Boston Children’s Hospital highest in more specialties than any other
children’s hospital in the country. Our world-renowned craniofacial
team will use innovation, collaboration, and the most modern treatment techniques to lead to the best outcomes
for your child and your family.

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