What Is Involved in Craniosynostosis Surgery?

Several options are available for craniosynostosis surgery, a procedure where a surgeon corrects prematurely fused skull plates to allow an infant's head to develop normally. This surgery typically occurs early in life. A more invasive open procedure was standard until the development of successful endoscopic techniques that are less aggressive and come with fewer risks. A surgeon may be able to perform either by request.

In traditional craniosynostosis surgery, the patient receives general anesthesia and is positioned on an operating table so the surgeon can access the relevant area of the skull. The surgeon makes a zigzag incision, designed to reduce the appearance of scarring by allowing hair to fall more naturally. Next, the surgeon accesses the area of interest, removes and reshapes bone, and then replaces it before adding plates and screws to hold it in place with room to grow. Fixation after surgery is important to help the skull retain its shape.

This surgery can take longer and carries the risk of infection and other issues. The deep incision could potentially intersect with a key facial nerve and may cause nerve damage. There's also a risk of adverse reactions to anesthesia. This risk can increase the longer the patient stays under, even with supervision from an attentive anesthesiologist and surgical team.

The alternative is endoscopic craniosynostosis surgery. In this procedure, the site is accessed through small incisions that allow a surgeon to reach the bone successfully. Instead of using screws and plates, the surgeon designs a helmet for the baby to wear. While helmet wear is not very comfortable and it can be hard to adhere to the regimen, it is safer and causes fewer complications than the use of external fixation to hold the skull in place. Patients may have reduced risks of infection and other complications with this procedure.

In both cases, after craniosynostosis surgery, the surgeon will want to see the patient for followups. At these appointments, the doctor can request medical imaging studies of the skull to check for signs of complications, and can also assess the shape of the head. With helmet wear, this is especially important, as a poorly fitted or improperly worn helmet might push the skull out of shape. If any adjustments are necessary, the doctor can make them to get the patient's skull development back on track. Patients who receive craniosynostosis surgery can make a full recovery and experience normal skull development after surgery.