Minimally invasive surgery provides new option to guide skull shape in infants with complex craniosynostosis

An innovative, minimally-invasive surgical approach can improve head shape while enabling normal brain development in infants with complex types of the skull deformity craniosynostosis, reports a paper in The Journal of Craniofacial Surgery. 

The combined spring-mediated cranioplasty and distraction osteogenesis technique offers an alternative for early intervention in infants with complex congenital skull deformities, suggests the preliminary report by Laura Galarza, MD, and colleagues of University of Mississippi University Hospital, Jackson.

'Significant improvement of head shape' with less-extensive surgery

Craniosynostosis is a common congenital deformity occurring when one or more joints (sutures) between the bones of the skull close prematurely. Some infants with craniosynostosis need surgical reconstruction of the skull to prevent complications related to increased pressure on the growing brain.

The patient in the new report was a 3-month-old girl with a complex form of craniosynostosis caused by early fusion of three different sutures, resulting in flattening of the right side of the head and protrusion (bossing) of the forehead area.

To manage this complex deformity, surgeons designed a procedure using distraction osteogenesis: a technique that takes advantage of the normal healing process to expand or stretch a bone. This was done using a less-invasive approach called spring-mediated cranioplasty. In this technique, the fused suture is removed (strip craniectomy) and custom-made, spring-loaded devices are applied to either side of the bone.

The spring devices placed gentle traction on the two sides of the bone, guiding continued skill growth. As the bone healed, traction was gradually increased: parents were instructed to turn a screw advancing the device every day, increasing the distance between the bone edges by one-half millimeter per day. Other than some mild tissue swelling, there were no complications of this bone-stretching procedure.

Treatment continued for about 3 months, until the new bone consolidated and the desired improvement in head shape was achieved. A minor surgical procedure was performed to remove the distractor hardware; the infant wore a helmet for several months to mold continued skull growth.

Sixteen months after the completion of therapy, the child had essentially almost near normal head shape. "On follow up there is significant improvement of the head shape and with evidence of near- complete ossification of the bone defects without the need for bone grafts," Dr. Galarza and coauthors write.

Because every case of complex craniosynostosis is different, treatment must be individualized to the infant's head shape and risks to the growing brain. Recent reports have showed that minimally invasive procedures such as distraction osteogenesis and spring-mediated cranioplasty are "safe and effective methods for gradually expanding the skull."

The new case report suggests that these techniques provide an effective alternative for early, minimally invasive surgery for complex craniosynostosis involving multiple sutures-improving the appearance of the head while providing adequate space for rapid brain development.

Compared to conventional cranial vault remodeling, the combined approach corrects the deformity in a less-extensive, less-traumatic surgery, with reduced risks of bleeding during surgery and infection after surgery. Mutaz Habal, MD, Editor-in-Chief of Journal of Craniofacial Surgery, comments, "This is an example of an innovative approach using multiple modalities to correct a common type of skull deformity, rather than limiting surgical options to a single procedure."