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Plastic and Reconstructive Surgery

Less invasive technique repairs skull defect

03/01/2010

Endocranial surgeryUCLA is the only hospital in the Los Angeles region and one of only a handful in the nation to offer a less invasive technique to repair craniosynostosis. A relatively common condition, craniosynostosis is the premature fusing of one or more of the sutures, or soft spots between bones, in a newborn’s head. The soft spots allow the skull bones to expand as the brain grows rapidly during the baby’s first year of life. If the sutures close too early, while the baby is still in utero, the brain’s expansion is restricted by the fused bones. The increased pressure on the brain can impair a newborn’s neurological development. The premature fusing of the sutures can also result in an abnormal head shape, which can be an aesthetic and social disadvantage.

Open surgery to fix defect

Traditional repair of craniosynostosis involves an open surgical procedure in which an incision is made from ear to ear and the scalp is peeled away from the skull bones. The fused sutures are removed, and the bones are cut and repositioned to give the brain room to grow. Depending on the number and type of closed sutures that need to be fixed, the open surgery can last up to six hours. A significant portion of the baby’s total circulating blood volume is lost during the procedure, and almost all patients who undergo it require multiple blood transfusions. The patient may be in the intensive care unit for a number of days and must remain in the hospital for several days after that for monitoring. There is a significant amount of swelling to the scalp and face, and a large scar that may be very conspicuous and cause the child discomfort.

Endoscopic repair offers advantages

UCLA’s Division of Plastic and Reconstructive Surgery offers a less invasive alternative to the open procedure, but with similar results: reduced pressure on the brain and the restoration of the normal contour of the skull. The surgeon makes strategically placed small incisions rather than a large ear-to-ear incision. Using an endoscope, the surgeon removes the fused sutures and make cuts to allow the cranial bones to expand and the brain to grow unimpeded. The total surgery and anesthesia time is significantly less than with the open procedure. The less invasive surgery reduces the blood loss and the need for transfusions. With smaller scars and less dissection, patients experience less swelling and discomfort, so recovery times are decreased and hospital stays are shorter.

Follow-up therapy

Following the endoscopic repair surgery, patients are fitted with a cranial orthotic helmet to help guide the head into a normal, round shape. The helmets, which are worn on average for six to nine months following the endoscopic repair, are well tolerated by babies.

Candidates for endoscopic surgery

Not all babies born with craniosynostosis are good candidates for the endoscopic repair. Infants with mild or moderate craniosynostosis are eligible for the endoscopic technique; those with a more severe deformity will get better results from the open procedure. The endoscopic technique must be performed early, ideally on babies about 2 months old. Because the endoscopic technique is dependent on molding skull shape through the use of a helmet, patients benefit from as many months as possible of rapid brain growth between the time of the surgery and the end of the helmet therapy.

Early referral key to less invasive treatment

The sooner surgeons examine a baby with craniosynostosis, the more likely it is that the child will be a candidate for the endoscopic repair option. Pediatricians are urged to refer their patients at the first suspicion that a misshaped skull may be caused by something other than molding from a vaginal delivery or the baby’s sleeping position.

“We are not seeing all of these patients soon enough,” says Reza Jarrahy, M.D., assistant professor of plastic and reconstructive surgery, who performs the endoscopic craniosynostosis repair at UCLA. “Oftentimes these kids are followed for a few months by their pediatricians and by the time they’re referred to me, even if their deformity is mild or moderate, they are no longer candidates for the less invasive endoscopic technique.”

“If the child is too old by the time I see them, then we’ve missed the opportunity,” explains Dr. Jarrahy. “I would like to be able to offer this less invasive option to more parents.”


Participating Physician

Reza Jarrahy, M.D.
Assistant Professor, Division of Plastic
and Reconstructive Surgery
David Geffen School of Medicine at UCLA

Contact Information
(310) 825-0065 appointments,
consultations, referrals
www.plasticsurgery.ucla.edu 





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