patient education series: craniosynostosis › documents › 2014 › 03 ›...
TRANSCRIPT
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Patient Education Series: Craniosynostosis
Steven R. Cohen M.D.Ralph E. Holmes M.D.
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Craniosynostosis
• Cranio= skull• Synostosis= fusion of open areas (sutures)
of skull• Fusion of sutures, depending on type lead to
characteristic head deformities
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How is Craniosynostosis Diagnosed?
• The skull deformity is easily recognized• A CT scan confirms the diagnosis• A Craniofacial and Pediatric Neurosurgeon
make the final diagnosis• A geneticist is consulted in unusual cases
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What are my Child’s Treatment Options?
• In mild cases, your child can be followed closely
• In most cases, because the deformity is progressive, surgical treatment is recommended
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What are the Surgical Options?
• At our institution, several options are available
• One, is an open approach• Another, is an endoscopic or minimally
invasive approach
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Reasons for Treatment
• Increased intracranial pressure• Globe protection• Airway protection• Disfigurement
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Open Approach
• The incision is hidden in the hair and goes from ear to ear
• This is the traditional approach and involves a team of Craniofacial and Pediatric Neurosurgeon
• The abnormal suture is opened and the bones are surgically repositioned and held in place with resorbable devices
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Right Coronal Synostosis- 4 months
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Right Coronal Synostosis- 4 months
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Unicoronal Synostosis- 4 years
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Unicoronal Synostosis, A.R. Pre-Op
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Compensatory Growth in Unicoronal Synostosis
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Unicoronal Synostosis, A.R. Pre-Op
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Unicoronal Synostosis, A.R. Intra-Op
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Unicoronal Synostosis, A.R. Intra-Op
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Unicoronal Synostosis, A.R.Pre-Op 1 yr. Post-op
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Postoperative Unicoronal Synostosis with Elevated ICP
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Skull Vault Expansion with Correction of ICP
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Endoscopic, Minimally Invasive Approach
• Small incisions will be made in the scalp within the hair and sometimes along the crease of the upper eyelids
• Using a small lighted endoscope, the operation will be projected onto a T.V. screen
• Resorbable devices may be used for bone stabilization
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Endoscopic, Minimally Invasive Approach
• Post-operative helmet or band will be prescribed in many cases to “fine tune” the shape of the skull
• The helmet may be needed up to 3 months• Your child will be fitted with a helmet 10 to
14 days after the operation
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S.W.- 2 month old girl with Sagittal Synostosis- Before and 3 months
after Endoscopic Correction
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S.W.- 2 month old girl with Sagittal Synostosis- Before and 3 months
after Endoscopic Correction
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Endoscopic Assisted Correction of Metopic Craniosynostosis With
Immediate Reconstruction
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Endoscopic Assisted Correction of Metopic Craniosynostosis With
Immediate Reconstruction
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Endoscopic Assisted Correction of Metopic Craniosynostosis With
Immediate Reconstruction
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Endoscopic Assisted Correction of Metopic Craniosynostosis With
Immediate Reconstruction
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Endoscopic Assisted Correction of Metopic Synostosis, 7 m.o., D.D.
Pre-Op Post-Op
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Endoscopic Assisted Correction of Metopic Synostosis, 7 m.o., D.D.
Pre-Op Post-Op
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Endoscopic Correction of Unicoronal Synostosis
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Outfracture of Right Fronto- orbital Segment and Stabilization
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Mesh Design
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3 Month Old with Right Coronal Synostosis
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3 Month Old with Right Coronal Synostosis
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3 Month Old with Right Coronal Synostosis
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Intraoperative Planning
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Upper Eyelid Incision and Exposure
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Subgaleal Exposure
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Rongeur to Start Coronal Strip Craniectomy, Completed with Scissors
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POD 2
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Before and 6 Weeks Postop
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Before and 6 Weeks Postop
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Post-operative Recovery
• Surgery takes from 2-4 hours• After surgery, your child will first go to the
recovery room, where the breathing tube is removed
• Then, your child will be transferred to the floor, to an Intermediate Care Unit (IMU) or to Intensive Care (ICU)
• Your child will have a head dressing
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Post-operative Recovery
• On the floor, your child will be placed on a monitor overnight
• Through a small tube in your child’s vein, salt and sugar water will be given until your child is feeding normally
• They will also receive antibiotics and pain medication
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Post-operative Recovery
• Your child’s head and face will swell and the eyes may swell shut for several days
• The swelling is worst at 48 hours• Swelling is normal and does not hurt your
child• Soon it will go away and by 2 weeks your
child will appear normal
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Discharge
• Once your child’s eyes start to open and your child is eating and taking oral pain medications , they will be discharged home
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Discharge
• Your child will be given oral pain medications and antibiotics and you will be be allowed to wash their hair
• A return appointment will be made with the Pediatric Neurosurgeon and the Craniofacial surgeon one to two weeks after discharge
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Discharge Directions• Schedule a follow-up appointment with your
doctors 1-2 weeks after discharge• Call your doctor’s office (Craniofacial
Surgery= 858-576-1700 Ext. 4255 or 858-292-1097 [24 hour line]; Neurosurgery= 858-576-1700 [24 hour line]) with questions or problems
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Long Term Followup
• Long term problems with the shape of the head and face and more rarely, neurologic and visual disorders can occur
• Your child will be followed every 6 months until 2 years of age, then yearly until around 8 or 9 years old
• In more complex cases, your child will be seen at the Children’s Hospital Craniofacial Team on a yearly basis
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Thank You