Our craniofacial team, led by Plastic Surgeon, Dr. Constance M. Barone and Neurosurgeon, Dr. David F. Jimenez, has developed and successfully performed a newer and less invasive technique for the treatment of patients with craniosynostosis in the last twelve years.
Craniosynostosis, a relatively common condition occurring in as many as one in one thousand births, is universally treated with surgical operations. Resection or removal of the affected suture has been tried in the past with limited and variable success rates. As such, surgeons historically have moved towards larger, more extensive and invasive operations with the goal of improving outcomes and results. Although results with these calvarial remodeling procedures have indeed improved, the patients have paid a higher price in terms of increased swelling, pain, bleeding, blood transfusions rates, increased complications and longer hospitalizations.
Even though we have performed traditional surgery for many years with very good results, our goals have been to decrease complications, surgical trauma and need for transfusions while obtaining excellent results that compare favorably or are even better than traditional surgery results. During the past decade, we developed minimally invasive techniques, aided by the use endoscopes, to achieve the desired results with remarkable consistency and safety.
The basic and fundamental principle with our treatment approach is to operate on the patient with craniosynostosis as early as possible. Best results are obtained when the patient is operated by 12 weeks of age. Nevertheless, very good outcomes can be obtained even with patients treated six or more months with appropriate postoperative helmet therapy.
Our approach is the release the prematurely closed suture and to allow the rapidly growing brain to remodel the skull and face to a normal shape. Depending on which suture is affected, our procedures have been designed to provide the most optimal results. Following surgery, the desired shape of the head and face is attained with the use of custom made helmets that are worn continuously over the ensuring months.
We welcome you to our website which we know you will find instructive and educational. For more information, you may contact us at 210-567-5625, where our highly skilled and trained nurses will contact your with the desired information.
SAGITTAL SUTURE SYNOSTOSIS
The endoscopic treatment of sagittal craniosynostosis is done via two small incisions. One is placed behind the anterior fontanel (soft spot) and the other is placed further back on the head. The endoscopes are used to expose the areas above and below the skull, including the affected suture. Also, with endoscopic aid, the involved bone is removed, thereby freeing the brain and the skull to expand normally.
CORONAL SYNOSTOSIS
Dissection endoscopic release of the closed coronal suture is performed via a small single incision located halfway between the soft spot and the ear on the involved side. In all cases, only a very small amount of hair is removed. The stenosed suture is resected with bone cutting scissors and instruments. Unlike traditional treatment, facial and orbital swelling is not seen and minimal pain is experienced by the patients.
METOPIC SUTURE SYNOSTOSIS
The treatment of metopic suture synostosis is done via a single incision placed behind the hair line and across the mid-line. The endoscopes are used to elevate the scalp over the suture from the anterior fontanel down to the root of the nose (nasion). Once a small opening is made on the skull, the endoscopes are inserted under the bone and used to visualize the bone under the affected suture. A small strip of bone (0.7mm) is typically removed from the anterior fontanel to nasion, thereby releasing the closed stenosed suture.
LAMBDOID SUTURE SYNOSTOSIS
For releasing stenosed lambdoid sutures, two 1" incisions are made in the back of the head. One is made over the midline and the second one behind the affected ear. In a similar fashion, the stenosed lambdoid suture is removed with the aid and visualization of an endoscope. As with other sutures, the incisions are closed with subcutaneous absorbable sutures which do not require subsequent removal.
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