Pediatric Neurosurgery: Craniosynostosis
The growth of the brain drives the growth of the skull. When there is an abnormal
fusion (premature closure) of one or more of the sutures (joints), it causes the
skull to grow in an exaggerated manner at the site of other non-fused sutures. This
condition, called craniosynostosis, results in an abnormal cranial
shape that worsens over time without treatment.
UF Health physicians Dr. Barry Steinberg and Dr. Nathan J. Ranalli are part of the
Jacksonville Cleft and Craniofacial Program, a multidisciplinary team of physicians
who treat children with craniofacial conditions, such as cleft lip, cleft palate
Types of Craniosynostosis
Sagittal craniosynostosis occurs when there is a fusion of the suture running along
the midline of the skull. Because the head cannot grow in width, it grows in length
to accommodate the expanding brain. This is the most common form of single-suture
In metopic synostosis, the fusion is located in the center of the forehead, resulting
in a pinched, triangular shape.
Coronal synostosis affects the suture or sutures between the frontal and parietal
bones, resulting in deformity of the forehead, brow and eye sockets.
Surgery is the only way to treat craniosynostosis. Patients will undergo an evaluation
by Dr. Steinberg and Dr. Ranalli in order to determine the best possible treatment
plan. The two options are endoscopic craniosynostosis repair or open repair.
Endoscopic Craniosynostosis Repair
This minimally invasive approach is an innovative surgical procedure for infants
younger than six months old.
The physicians will introduce an endoscope through one or two small incisions, each
less than two inches in length, on the top of the head. Portions of the skull are
removed in several places, including along the closed suture, to release the fusion.
No plating or reconstruction is necessary. Instead, a custom molding helmet will
be made for the patient a week after surgery to complete the reshaping of the skull
following the procedure.
This type of surgery offers many potential advantages, including decreased blood
loss and operating time, smaller scars, less pain and swelling, and a shorter hospital
This surgery is performed in patients who are 10-12 months old, but can be performed
later for children who have had a delayed diagnosis.
During the operation, an incision is made on the top of the head from ear to ear
and bone from the skull is removed, reshaped and then replaced with plates and screws
that eventually dissolve.
The scalp is closed in such a way that minimizes scarring. Some patients may require
a blood transfusion if necessary. Although this approach produces slightly more
swelling, discomfort and a longer hospital stay, children generally go home three
to five days after surgery with minimal pain medications and few special care instructions.
The Jacksonville Cleft and Craniofacial Program offers access to experts who provide
specialized care in craniofacial surgery, neurosurgery, plastic surgery, otolaryngology,
dentistry, orthodontics, speech and language pathology, audiology, nursing and social
Working closely with each child, his or her family and primary care doctor, the
team develops a coordinated treatment plan to achieve optimal results for his or
her specific needs.