|The first surgical treatment of
craniosynostosis was undertaken by Lannelongue in 1892,
and involved the correction of a sagittal synostosis.
Since then, multiple procedures have been used for the
treatment of this condition, ranging from simple
suturectomies (removal of fused sutures without skull
remodeling to extensive cranial vault reconstruction.
The type of surgery done for craniosynostosis is unique
to the surgeon performing the repair and unique to the
suture is fused. I encourage parents to thoroughly
research all their options before deciding which surgery
is best for your child. Second and third opinions from
different craniofacial surgeons are recommended if you
are unsure of the first consult.
SURGERY FOR CRANIOSYNOSOSIS
Cranial Vault Reconstruction also known as CVR or
traditional surgery is the most common surgery
performed. It is a complex surgery and will require the
use of both a paediatric neurosurgeon/Neurosurgeon and
paediatric craniofacial surgeon.
Some surgeons prefer to do either just the front of the
skull (anterior CVR) or just the back of the skull
(posterior CVR). While other surgeons might choose an
overall CVR depending on the degree of reconstruction
needed. In some cases front orbit advancement (FOA) is
performed to reconstruct the orbits around the eyes.
FOA's are hardly ever performed without an accompanying
An incision is made in the scalp from ear to ear in
either a zig-zag pattern or u-shape. The skull bones are
then cut and removed by a paediatric neurosurgeon. A CVR
should never be performed without the neurosurgeon whose
job is to protect the durum that surrounds and protects
the brain. A paediatric craniofacial surgeon then will
reconstruct and piece the skull bones back together
using plates, screws, and stitches. Most of these
foreign objects are absorbable which means as the new
bone grows the plates and screws will slowly disappear.
CVR Surgery Pro’s:
- Immediate and often lasting correction of the
deformity without any visible or palpable bony
- Drastically reduced occurrences of secondary
- More qualified surgeons available to perform CVR
- CVR is most successful when performed on
children younger than one year of age but is highly
successful when performed on even older children
- Any complications with the durum or blood loss
can be immediately handled.
- Most successful treatment for multi-suture
synostosis and severe cranial deformity.
CVR Surgery Con’s:
- Blood loss with the need for blood transfusions
- Highly invasive surgery that last 5 to 9 hours
- Plates and screws most often are needed
- 48 hour stay in ICU required , followed by 3 or
4 more days in hospital
- Swelling and bruising
Most commonly an incision is made across the scalp
from ear to ear in a zig-zag or u-shaped pattern.
However in some cases of Sagittal the incision has been
made from the front of the scalp to the back across the
middle. A strip of bone is usually removed where 2
sutures connect and cuts are usually made down the sides
of the skull to allow for natural reshaping as the brain
grows. Sometimes smaller pieces of bone are removed and
the skull is then allowed to be remoulded as the brain
grows and the open spots allow the natural growth to
This too is an open procedure so an incision is
typically made from ear to ear. Strips and pieces of
bone are removed and repositioned with some gaps and in
places where reconstruction is needed the bones are cut
into smaller, flowering shapes that will move and
conform with the brain as it grows. Bone sometimes can
be stitched back together without need of plates and