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The newborn baby’s brain undergoes an extremely rapid rate of growth and development. It is estimated that the volume and size of the newborn’s brain doubles in nine months and triples in 36 months. To accommodate such rapid growth, the skull bones must expand rapidly at the location of the sutures. These sutures respond to brain growth by expanding and producing new bone, thereby allowing the skull to reach an adult size along with the underlying brain.
Should any of these sutures fuse while the brain is growing, a condition called craniosynostosis occurs. In isolated craniosynostosis the infant’s brain is unaffected; therefore, the brain will continues to grow. However, the fused suture inhibits skull growth perpendicular to the suture which results in distortion of the infant’s head shape. The sagittal suture is the most common form of single suture craniosynostosis (1:1000) called scaphocephaly. It results in a long narrow shaped skull and has been linked to developmental delay if left uncorrected.
The traditional treatment modality has been a complete cranial vault remodeling procedure whereby the calvarium is removed, reshaped and secured back to the skull base. The procedure can take up to six hours and requires blood transfusions for the infant, pediatric intensive care monitoring, and several days in the hospital.
In 1998, Claes Lauritzen in Sweden introduced a less invasive procedure called spring assisted surgery. This technique requires removal of the sagittal suture in a one centimeter strip from the anterior portion of the skull to the posterior portion. Two Omega-shaped stainless steel springs are then placed in the gap to facilitate lateral distraction of the skull. This prevents the premature re-fusion of the skull bones and encourages skull expansion. The operation takes less than an hour and has significantly lower blood loss which eliminates the need for any blood transfusion. The child spends the night in the pediatric ward for routine post-operative monitoring and is discharged the next morning. The child will have the spring removed as an outpatient procedure around six months later once the bone gap has reossified.
Dr. Claire Sanger, who arrived in the Plastic Surgery Division this year, brings significant experience in spring assisted surgery for treating craniosynostosis. As a resident at Wake Forest University Medical Center in North Carolina, Sanger was part of a team which tested the procedure for its safety and efficacy in the laboratory. The team, headed by Dr. Lisa David, further advanced the design of the spring and subsequently obtained institutional and FDA approval for use in the patient population. Consequently, in 2001 the Wake Forest University team became the first in the nation to employ spring assisted cranioplasty in infants. In addition, Dr. Sanger spent one year in Sweden participating in a craniofacial fellowship with Dr. Claes Lautizen, the father of the procedure.
The Craniofacial Team at the University of Kentucky, under the leadership of Dr. Henry Vasconez, is now the third center in the nation to offer minimally invasive cranial expansion by way of spring assisted surgery for craniosynostosis. In August, Dr. Thomas Pittman from the Neurosurgery Department and Dr. Sanger completed the procedure for the first time at UK.
“The entire staff had everything well prepared,” Dr. Sanger said. “Thanks to all the preparation the case went as smoothly as if it was a routine case. The patient started feeding on her bottle in the post-operative recovery area and went home the following morning after she and her parents had breakfast.” Two additional patients with sagittal synostosis are scheduled for surgery the first of September.
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