Monday, March 13, 2017

Ask The Doctor: Second Opinion for Saggital Craniosynostosis

CCA posts a monthly blog series called, "Ask the Doctor." You can submit your questions to Annie Reeves ([email protected]) and we will ask Dr. Earl Gage of Kids' Plastic Surgery in St. Louis to answer them. Thanks Dr. Gage for helping spread information and resources for our cranio families!

Ask The Doctor
Earl Gage, MD
Kids Plastic Surgery, Mercy Children’s Hospital – St Louis, MO

Question: We had surgery October 25 for saggital craniosynostosis. He had an 8x4 section removed along with relief cuts on the side. At our six week check up I mentioned and the doctor confirmed that his entire skull had regrown already. We are on our second helmet to try and shape the head but it is 10mm longer (footballish) than before surgery.
I love our craniofacial surgeon but wonder if a second opinion is necessary? It seems awfully fast for the bone to regrow and I'm worried we should be looking at, or preparing for, another surgery.

Answer:  Thanks for your question. I presume that your baby had endoscopic assisted suture removal where a limited section of bone was removed through small incisions. Endoscopic assisted surgery is gaining acceptance as a good technique for treating craniosynostosis because if offers smaller scars, shorter surgery times, shorter hospital stays and less risk of needing blood transfusion. In experienced hands, the outcomes in sagittal synostosis are also quite good with normalization of skull shape in most cases. In order for the surgery to work well in correcting the head shape, it is important to remove a wide enough section of bone and release the fused suture completely. It is also critical, in my opinion, that parents are compliant with molding helmet therapy after the surgery and that teams use an experienced orthotist to make the helmet and monitor for proper fit. While I am aware that helmets are not used in some places in conjunction with endoscopic assisted suture release, I believe the best results are achieved when a helmet is used in conjunction with surgery. Parents should anticipate that their baby will need the helmet until approximately 1 year of age. The helmet should be worn 23 hours a day.

The fact that your baby’s cranial bone seems to have re-grown quickly is not surprising. In fact, this is normal. If the head shape is not correcting or is worsening, this can be the result of not having had enough bone removed, incomplete release of the suture or a molding helmet that is not fitting properly or not being worn as instructed. These are things to check and discuss with your team. Although it is rare to need a second surgery, sometimes repeat surgery is recommended due to inadequate correction of the head shape. When deemed necessary, any repeat surgery would likely be done as a traditional, open surgery.  It is never wrong to seek a second opinion if you have concerns. Most surgeons will be OK with this. It is always OK to be a strong advocate for your baby.

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