Cranioplasty with barrel stave osteotomies to treat sagittal suture craniosynostosis.
Craniosynostosis can cause skull malformations, including scaphocephaly, resulting in increased intracranial pressure and abnormal brain development. Likewise, patients may suffer from headaches and seizures.
Infection, hydrocephalus, brain swelling
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
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: immediate increase in cranial cavity space and ability to easily adjust
Disadvantages: invasive, long time under anesthesia
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)
Michael Golinko MD, Kumar Patel PA
Eylem Ocal MD
Arkansas Children’s Hospital
University of Arkansas for Medical Sciences
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