Endoscopic Craniosynostosis Repair | St. Louis Children’s Hospital

Baby Jack is a happy, healthy little boy. People said we won the baby lottery. Doing what most three month olds do. During the day, he’s just all smiles and giggles. With one exception. The pediatrician towards the end of the exam, mentioned the concern about his head shape and everything and I kind of, it was overwhelming. His sagittal suture, it was confirmed that that was fused prematurely. In most patients, those joints fuse when you’re a young adult. And rarely they fuse too early and the skull doesn’t grow normally, it gets in different skull shapes. Jack has what is called cranialsynostosis. These are open sutures. They’re able to create bone, they’re able to lay down bone in this direction. This is the synostosis suture. It’s unable to lay down bone in this direction. The brain keeps growing and rather than slowing down, these work overtime. Since you can’t grow in the lateral direction, you’re going to get extra compensation of growth in the front to back direction. And you’re going to end up with a long and skinny head. Looking at the general head shape, the skull was elongated, front to back. And the forehead is bulging out more than is normal. Jack needs surgery to remove some of the fused bone and restore his head shape. Now his parents must decide whether to choose the traditional approach or a newer endoscopic procedure. In the open traditional technique, there’s a much larger access incision typically over the crown of the head. From ear to ear an incision would be made, opening that entire scalp. The endoscopic method also means less time in the operating room under anesthesia, less blood loss, and less swelling. Wear and tear on the child seems to be significantly less. The child is able to go home typically on the first or second postoperative day. They are feeding within eight to twelve hours versus really taking a couple days to get over the procedure enough to be feeding reliably using the open technique. The surgical team, plastic surgeon Alex Kane and neurosuregeon Matthew Smith, helped Jack’s parents make the best decision for them. It was nice because we met with them individually and they were both able to answer any question we had and they both have very open personalities. We knew what was going on, but you never, I don’t think ever, truly know what to expect when your child’s going into surgery. After talking with both of them, we’re very comfortable with what the information they had to offer and how they would collaborate doing the surgery together. We do the surgery together. It requires four hands working simultaneously where all four hands know what the next hand is going to be doing, in terms of maneuvering the scope and the instrument and the light source. So it really is kind of a concert where we both work together. So that little scope which is a slender metal pole with a little camera on it goes into that small bone incision and then it separates the brain and the coverings of the brain from the ball. For the sagittal synostosis, actually relatively large piece of bone at the top of the head. The whole suture that’s involved with about an inch on either side is removed so the soft spot becomes very large. Surgery is a success. Right in recovery room he had his eyes open looking at us, eating, and I mean we could recognize him. I was afraid after the surgery, you know, with the swelling and possible bruising, we wouldn’t be able to recognize him. And I mean he’s just perfect. Over the last 24 hours you can really see that the bones are starting to expand a little bit and get to a point where they are supposed to be and that’s just over the last 24 hours so we’re definitely noticing a difference. It’s a little scary. Surprised at how quick he recovered. Well, that’s the whole point of the procedure so If you didn’t see his little incision, which pretty much completely healed, you would have had no idea that he had surgery. It’s amazing. Unlike the traditional more invasive procedure, the endoscopic craniosynostosis repair requires that Jack wear a helmet until his first birthday. This is your new best friend. It’s a combination of the helmet applying a little pressure front to back, as well as, the brain zone normal expansion and growth over time to remodel the skull shape. As the next week and months go by, he’ll have frequent adjustments and monitoring the helmet to make sure that we’re achieving a good correction as he grows. He’s doing great. It’s hard to believe he had that surgery just a short time ago. No we have no regrets. We have to, you know, this is part of life and a little bump in the road and we’re working our way through it. It’s just something that’s gonna make him stronger and make him who we is.

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