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Craniosynostosis surgical techniques fact sheet

Craniosynostosis surgical techniques

Craniosynostosis occurs when some of the flexible areas between the bone plates in the skull (known as sutures) close over (fuse) prematurely, stopping the baby’s head from growing normally. Different surgical techniques are used to correct this condition depending on which suture has fused:

Total cranial vault remodelling

Total cranial vault remodelling is used when the sagittal suture has fused early. This operation involves removing all bones of the skull above the level of the eyes as four separate pieces of bone, then re-shaping them to change the overall skull shape. The operation shortens the long skull from front to back, widens the narrow skull side to side and decreases the amount of prominence of the forehead area.

The operation always achieves a more normal shape but individual results will depend on factors including the severity of the original deformity, the thickness of the bones at the time of surgery and the patient’s age.

A relapse following surgery is uncommon and rarely requires secondary surgery.

Bi-fronto orbital remodelling

Bi-fronto orbital remodelling is used when the metopic suture has fused. The operation changes the forehead from a sharply angled shape with a prominent midline crease to a gentle curve. The bones over the top of the eyes and the brow area are also reshaped to form a gentle curve and the bones at the outer part of the brows are moved forward to a more normal position.

After the operation, the forehead and bones above the eyes may look prominent or square in shape, but this is temporary. The over-correction of the bones (and obvious prominence) is deliberate and allows for an expected partial relapse over the months following the operation.  This approach usually results in the correct skull shape in the longer term.

Occasionally a relapse occurs, resulting in the outer parts of the temple becoming slightly hollow. This can be corrected with a minor filling procedure.

Fronto-orbital remodelling

Fronto-orbital remodelling is used when one coronal suture is fused. The operation removes and remodels the forehead and bones over the top of the eyes and brow to give the forehead more balance on both sides. This involves moving the forehead and the eyebrow bones forward on the side of the coronal craniosynostosis and remodelling to create a more natural shape to match the opposite side.

A relapse following surgery is uncommon and rarely requires secondary surgery.

Bi-fronto orbital advancement

Bi-fronto orbital advancement is performed when both coronal sutures are fused. This technique involves removing the forehead bone and separating the bones across the top of the eyes and brow area. The bones are reshaped and moved forward into a more appropriate position. This gives the brain more room for growth, reduces the risk of brain pressure problems and improves the appearance of the forehead area. Occasionally, an operation is needed to make more room at the back of the skull. This will occur before the operation on the forehead region. These two operations will be separated by at least six months.

A relapse following surgery is uncommon and rarely requires secondary surgery.

Posterior cranial vault remodelling

Posterior cranial vault remodelling is performed when one of the lambdoid sutures is fused. This involves removing the bones at the back half of the skull and remodelling to improve the shape of the flat area and create a more rounded and symmetrical back of the skull.

A relapse following surgery is uncommon and rarely requires secondary surgery.

Surgery risks

There are always possible risks with a major surgery involving an anaesthetic. Please speak to your surgeon or a member of your medical team if you have additional questions or concerns.

Serious risks

  1. Bleeding
  2. Occasionally bleeding is more than expected and can be potentially life-threatening. In rare cases, serious bleeding occurs and the operation cannot be completed as planned. In these situations, the operation may be performed later.

  3. Infection
  4. Infection sometimes occurs in the days, weeks or months following cranial surgery. This may mean further operations and hospital stays are needed to try to remove the infection and help the wound to heal. The infection may also cause soft spots or gaps in the skull. This may need corrective surgery later.

  5. Injury to the brain or the lining around the brain
  6. It is extremely unusual for the brain to be injured during cranial surgery. However, a tear may occur in the lining of the membrane around the brain. If this occurs, the tear is usually stitched and rarely causes any problems. On rare occasions, the tear may leak brain water and further operations may be needed to seal the leak.

Less serious risks

  1. Bone irregularities
  2. The skull will always look more normal after surgery. However, the operation will cause some bone irregularities and bumps. These will be obvious immediately after the operation, are usually minor, and will improve and soften over time.

  3. Bone gaps
  4. Gaps between the bone plates are common after remodelling surgery. These will usually fill in with bone over time (months to years). These gaps rarely cause medical difficulties and will not restrict your child’s activities. However, these can later be filled in through reconstructive surgery.

  5. Noticeable wires or plates
  6. Wires rarely cause medical problems and usually don’t require removal. However, on rare occasions, a wire may irritate the overlying skin and your child will need surgery to remove it. This procedure takes around 10 minutes, requires an anaesthetic and will be performed as day surgery. Swelling can also develop around the plates if your child bumps their head around the area. However, this will usually resolve spontaneously within a few weeks.

  7. Scarring
  8. The scar may be wide and pink in colour for a while after the operation. If the scar is wider than expected and can obviously be seen, a procedure to reduce the scar may be needed.

  9. Subtotal correction of the abnormal skull shape
  10. There may be some shape issues that are not fully corrected by cranial surgery. In some cases, a second operation may improve the shape of the skull.

  11. Relapse
  12. Relapses sometimes occur but the skull will never return to its original, abnormal shape.

Contact us

Cleft and Craniofacial Surgery
Queensland Children’s Hospital
501 Stanley Street, South Brisbane 4101
t: 07 3068 4321 (business hours)
t: 07 3068 1111 (after hours – ask for plastic surgery registrar on call)

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

Resource No: FS302. Developed by the Neurosurgery, Plastic and Reconstructive Surgery Department. Updated: May 2016. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.

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