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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 and craniosynostosis.

Types of Craniosynostosis

  • Sagittal 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 synostosis.

  • Metopic Synostosis

    In metopic synostosis, the fusion is located in the center of the forehead, resulting in a pinched, triangular shape.

  • Coronal Synostosis

    Coronal synostosis affects the suture or sutures between the frontal and parietal bones, resulting in deformity of the forehead, brow and eye sockets.

Treating Craniosynostosis

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 stay.

  • Open Repair

    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 work.

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.