Craniosynostosis

Diagnosis

Craniosynostosis requires evaluation by specialists, such as a pediatric neurosurgeon or a specialist in plastic and reconstructive surgery. Diagnosis of craniosynostosis may include:

• Physical exam. Your health care provider feels your baby's head for features such as suture ridges and looks for facial differences such as unbalanced features.
• Imaging studies. A computerized tomography (CT) scan or magnetic resonance imaging (MRI) of your baby's skull can show whether any sutures have fused. Cranial ultrasound imaging may be used. Fused sutures can be identified by their absence — because they're invisible once fused — or by a ridging of the suture line. A laser scan and photographs also may be used to make precise measurements of the skull shape.
• Genetic testing. If your health care provider suspects an underlying genetic syndrome, genetic testing may help identify the syndrome.

Treatment

Mild cases of craniosynostosis may not need treatment. Your health care provider may recommend a specially molded helmet to help reshape your baby's head if the cranial sutures are open and the head is misshapen. In this situation, the molded helmet can assist your baby's brain growth and correct the shape of the skull.

However, for most babies, surgery is the primary treatment. The type and timing of surgery depends on the type of craniosynostosis and whether there's an underlying genetic syndrome. Sometimes more than one surgery is required.

The purpose of surgery is to correct the head shape, reduce or prevent pressure on the brain, create room for the brain to grow properly, and improve your baby's appearance. This involves a process of planning and surgery.

Surgical planning

Imaging studies can help surgeons develop a surgical procedure plan. Virtual surgical planning for treatment of craniosynostosis uses high-definition 3D CT scans and MRI scans of your baby's skull to construct a computer-simulated, individualized surgical plan. Based on that virtual surgical plan, customized templates are constructed to guide the procedure.

Surgery

A team that includes a specialist in surgery of the head and face (craniofacial surgeon) and a specialist in brain surgery (neurosurgeon) generally performs the procedure. Surgery can be done by endoscopic or open surgery. Both types of procedures generally produce very good cosmetic results with low risk of complications.

• Endoscopic surgery. This minimally invasive surgery may be considered for babies up to age 6 months. Surgery done early is preferred. Using a lighted tube and camera (endoscope) inserted through small scalp cuts (incisions), the surgeon removes the affected suture to allow the baby's brain to grow properly. Compared with an open procedure, endoscopic surgery has a smaller incision, typically involves only a one-night hospital stay and usually does not require a blood transfusion.
• Open surgery. Generally, open surgery is done for babies older than 6 months. The surgeon makes an incision in the scalp and cranial bones, then reshapes the affected portion of the skull. The skull position is held in place with plates and screws that are absorbable. Open surgery typically involves a hospital stay of three or four days, and a blood transfusion is usually necessary. It's generally a one-time procedure, but in complex cases, multiple open surgeries are often required to correct the baby's head shape.

Helmet therapy

After minimally invasive surgery, office visits at certain intervals are needed to fit a series of helmets to help shape your baby's skull. The surgeon will determine the length of helmet therapy based on how quickly the shape responds to treatment. If open surgery is done, usually no helmet is needed afterward.

Coping and support

When you learn that your baby has craniosynostosis, you may experience a range of emotions. You may not know what to expect. Information and support can help.

Consider these steps to prepare yourself and to care for your baby:

• Find a team of trusted professionals. You'll need to make important decisions about your baby's care. Medical centers with craniofacial specialty teams can offer you information about the disorder, coordinate your baby's care among specialists, help you evaluate options and provide treatment.
• Seek out other families. Talking to people who are dealing with similar challenges can provide you with information and emotional support. Ask your health care provider about support groups in your community. If a group isn't for you, maybe your provider can put you in touch with a family who has dealt with craniosynostosis. Or you may be able to find group or individual support online.
• Expect a bright future. Most children have appropriate cognitive development and good cosmetic results after surgery. Early diagnosis and treatment are key. When needed, early intervention services offer help with developmental delays or intellectual disabilities.

Preparing for your appointment

In some cases, your baby's pediatrician may suspect craniosynostosis at a routine well-baby visit. In other cases, you may make an appointment because you have concerns about your baby's head growth. Your health care provider can refer you to a specialist for diagnosis and treatment.

Here's some information to help you get ready for your appointment. If possible, bring a family member or friend with you. A trusted companion can help you remember information and provide emotional support.

What you can do

Before the appointment, make a list of:

• Any signs you've noticed, such as raised ridges or a change in the shape of your baby's face or head
• Questions to ask your health care provider

Questions to ask might include:

• What's the most likely cause of my baby's symptoms?
• Are there other possible causes?
• What kinds of tests does my baby need? Do these tests require any special preparation?
• What treatments are available, and which do you recommend?
• Are there alternatives to the treatment you're recommending?
• What are the risks involved with surgery?
• Who will perform the surgery if it's needed?
• What happens if we choose not to have the surgery right now?
• Will the shape of the skull affect the functioning of my baby's brain?
• What is the likelihood of future children having the same condition?
• Are there brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask other questions during the appointment.

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

• When did you first notice the changes in your baby's head?
• How much time does your baby spend on his or her back?
• In what position does your baby sleep?
• Has your baby had any seizures?
• Is your baby's development on schedule?
• Were there any complications during your pregnancy?
• Do you have a family history of craniosynostosis or genetic conditions such as Apert syndrome, Pfeiffer syndrome or Crouzon syndrome?

Your health care provider will ask additional questions based on your responses. Preparing and anticipating questions will help you make the most of your appointment.