Cranioplasty for Sagittal Craniosynostosis

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Author: Sarah Gammill
Published:
Specialties: Craniofacial and Pediatric Plastic Surgery, Neurosurgery, Pediatric Surgery, Plastic Surgery
Schools: Arkansas Children's Hospital, University of Arkansas for Medical Sciences
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Basic Info

Cranioplasty with barrel stave osteotomies to treat sagittal suture craniosynostosis.

Advanced

Procedure

Cranioplasty

Indications

Craniosynostosis can cause skull malformations, including scaphocephaly, resulting in increased intracranial pressure and abnormal brain development. Likewise, patients may suffer from headaches and seizures.

Contraindications

Infection, hydrocephalus, brain swelling

Instrumentation

Setup

Patient was positioned prone with the incision site shaved and marked. Next, the patient was cleaned with chlorhexidine and the length of the incision was injected with local anesthetic containing epinephrine (for vasoconstriction). Re-making was necessary after sterile prep.
Foley catheter, arterial line, multiple peripheral venous lines (in case of bleeding), padding to avoid pressure, etc

Preoperative Workup

H&P, CT, standardized photographs, CBC, Coagulation profile, Anesthesia ASA categorization

Anatomy and Landmarks

Curvilinear coronal incision spanning through all five layers of the scalp. Dissect deep to periosteum both anterior and posteriorly. Craniotomy performed being mindful of the sagittal sinus as well as using care in the areas surrounding cranial sutures, where dura tends to more adherent.

Parietal Bone, Frontal Bone, Occipital Bone, Anterior Fontanel, Posterior Fontanel, Coronal and lambdoid sutures

Advantages/Disadvantages

Advantages: immediate increase in cranial cavity space and ability to easily adjust
Disadvantages: invasive, long time under anesthesia

Complications/Risks

Bleeding, infection (osteomyelitis), CSF leak, seizure, transient neurological defect, epidural or subdural hematoma, hydrocephalus, premature re-fusion of suture or full thickness skull voids (incomplete re-ossification of removed segments)

Disclosure of Conflicts

N/A

Acknowledgements

Michael Golinko MD, Kumar Patel PA
Eylem Ocal MD
Arkansas Children’s Hospital
University of Arkansas for Medical Sciences

References

Brooks E, Yang J, Beckett J, et al. Normalization of brain morphology after surgery in sagittal craniosynostosis. Journal of Neurosurgery. 2016; 17(4): 460-468

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