Skull bones have fibrous unions which are known as sutures which really serve two purposes. They allow the head to deform during the birth process and they also allow the brain to grow which is especially important during the first couple years of life. If you have premature fusion of one of these sutures, then you have craniosynostosis. The challenge with craniosynostosis is that we know that a significant number of children will go on to develop increased intracranial pressure but we can’t predict who those children are. And so for that reason, we generally treat all children with craniosynostosis with surgery for children who present early meaning. The first couple months of life they tend to have more options in regards to less invasive treatment. So for example they may be a candidate for an endoscopic strip craniectomy with post-operative helmet use whereas a child who presents later in life, usually say after six months of age, those children because significant amounts of brain growth have already occurred are better candidates often for open surgical procedures as opposed to endoscopic. One thing I try to always emphasize to my families is that craniosynostosis surgery is really bone surgery it’s not brain surgery. We stay on the outer aspect of the dura which is the protective layer over the brain and so the idea is to reconstruct the skull and to improve the head shape and again to remove the disease suture but it’s not to actually operate on their brain. And for that reason, these children tend to do very well. Usually a couple days in the hospital and then they’re back home and they really respond and heal remarkably fast.
Abnormal head shapes are extremely common. Most children who have a head shape abnormality secondary to a deformational process such as passing through the birth canal will have improvement with the head shape over time. If the head shape fails to improve, then often they’re referred to a craniofacial surgeon for evaluation for a possible underlying diagnosis of craniosynostosis. The doctor has to determine is this a issue related to a fuse suture meaning craniosynostosis or is this an issue related to repetitive positioning which often occurs during sleep and that is a positional plagiocephaly or a deformational plagiocephaly problem. That problem is non-surgical and in severe cases is treated with helmet therapy. Helmets usually are worn for about six to 12 months for about 23 hours a day to improve the head shape and what helmets do is they rely on underlying brain growth to remodel the skull essentially. And helmets help direct that growth as the child continues to grow so early initiation of helmet therapy, if one is going to pursue helmet therapy, is incredibly important because again you want to capitalize on residual brain growth during that period.