Cranial Vault Remodeling

Our physicians can treat children born with cranial abnormalities, such as those that may indicate a need for cranial vault remodeling.

This procedure involves the surgical removal and reshaping of fused cranial bones, or craniosynostosis, to allow for the natural growth and development of a normal skull. Versions of craniosynostosis treated with cranial vault remodeling include:

• Metopic synostosis: a fused suture (joint between 2 skull bones) in the front of the head, resulting in a pointed forehead
• Sagittal synostosis: a fused suture on top of the head from front to back, resulting in an elongated head, the most common type of synostosis
• Coronal synostosis: a fused suture on either or both sides of the head, near the front, resulting in an elevated and flattened eye socket
• Lambdoid synostosis: a fused suture on either or both sides of the head, near the rear, resulting in a misshapen back of the head

These conditions may occur in any infant, may be caused by inherited factors, occur as part of a larger syndrome or be completely sporadic. Once your infant has been examined by a craniofacial specialist, a CT scan will be performed to determine if there is increased pressure within the skull. In cases of increased pressure, the procedure is done quickly, but if there is no detected pressure, the surgery may be postponed until your child is 1 year old. While some mild cases of craniosynostosis can be left untreated, noticeable cases are typically handled with surgery in infancy.

Prior to the surgery, your infant should be well hydrated and feedings should be planned appropriately so that on the day of the surgery, it will be possible to stop all eating and drinking for a certain number of hours before the procedure. Just before the procedure, oral medication is given to induce drowsiness, and general anesthetic is administered in the operating room. Once your baby is asleep, an IV, breathing tube, catheter and arterial line are started. Typically, no shaving of the head is necessary.

An incision is made near the fused suture, usually across the top of the head, running from ear to ear. Your doctor will remove the abnormal or fused bone and remodel it to create the most natural results. The remodeled bone is returned to the head and attached in place using surgical screws and plates that will naturally dissolve in 12-18 months. Drains are left in place to relieve fluid build up in the area following surgery, and the incision is closed. Cranial vault remodeling typically takes 3-6 hours.

Typically, your infant will still have their breathing tube in place following the surgery, and possibly until the next day. They may also need to wear arm restraints as they sleep to ensure they do not damage the surgical site. Dressings may remain in place for 1-2 days, and drainage tubes for 2-4 days. Pain medication may be given if your child experiences discomfort or a sore throat. Your infant is encouraged to get out of bed as soon as they are able to do so. A typical hospitalization following cranial vault remodeling is 3-5 days.

There may be some swelling following the procedure, and your child's eyes will typically swell shut, but should open in a few days. The head may be washed 2 days after surgery with mild shampoo. Normal activities may be resumed following hospital discharge, but the head should be protected from accidental impact. Sutures should dissolve on their own in 4-6 weeks. A follow-up appointment will be scheduled sometime between 3-6 weeks from the date of the surgery.

Possible complications of this procedure include nausea, vomiting, headaches, irritability, drowsiness, redness, pain, fever and fluid leakage. Any unusual occurrence of these symptoms should be reported to our office immediately.

If your infant is suffering from craniosynostosis, contact us to discuss your surgical options.