CVR Cranial Vault Remodel for Craniosynostosis

The craniofacial surgeon will remodel or reshape the bones of the skull expanding and enlarging the space within the vault to allow room for your child’s brain to grow while attempting to restore a more natural appearing shape of the skull. The craniofacial surgeon and the neurosurgeon work together to perform the surgery as safely as possible.

This procedure involves the surgical removal and reshaping of fused cranial bones, or craniosynostosis, to allow for the natural growth and development of a normal skull.

This technique involves temporarily removing the skull bones (called a craniotomy), reshaping them, and replacing them to form the skull in their new shape and arrangement. The reshaped bones are secured using synthetic plates and dissolving screws, and sometimes dissolving sutures. A clear advantage of this versatile type of reconstruction is that it allows the surgeon to precisely reshape an area of, or the entire, skull. Also, the bones are reshaped in one surgery, and no helmet is required after surgery. 

Children with craniosynostosis benefit from a multi- disciplinary-team approach, which is used in most cran- iofacial clinics affiliated with major pediatric medical centers.2 The specialists usually include plastic surgeons, neurosurgeons, otolaryngologists, dentists, audiologists, ophthalmologists, speech pathologists, developmental pediatricians, neuropsychologists, medical geneticists, social workers, and nurses. Specialists (ie, cardiologists and gastroenterologists) are consulted for management of associated defects and clearance for surgery. Making appointments to meet all the specialists and processing all the information discussed can be overwhelming for patients’ parents.

After surgery for craniosynostosis, patients return to the pediatric intensive care unit for monitoring of hemo- dynamic status and level of consciousness. When the duration of surgery is long or blood loss is marked, the endotracheal tube may be left in place.

Vital signs are monitored for indications of hypo- volemia. Infusions of isotonic solutions are maintained until fluid shifts are complete, and hemodynamic, hematologic, and neurologic conditions are monitored until the risk for bleeding has passed.

The head dressing is monitored for concealed blood losses. Intravenous solutions with dextrose and physiological saline are administered to maintain adequate intake and output balance and prevent electrolyte imbalances. Blood samples are obtained for laboratory tests to monitor the hematocrit level and the serum level of sodium. Pain medications such as acetaminophen, morphine, and fentanyl are administered when needed. Pain and discomfort can be anticipated from not only the head incision but also the facial and periorbital edema that develops postoperatively.

The compression bandage on the head also helps limit scalp edema. Fever is not unusual for the first 72 hours.

Parents experience various stressors upon seeing their child in the intensive care unit, such as the child’s appearance, sights and sounds of the unit, procedures, the child’s behavior and emotions, and staff communica- tions.35 The facial swelling and the presence of drains in a child who has had surgery for craniosynostosis can be overwhelming. The swelling and the amount of drainage increase during the first few days and may deter the par- ents from holding the child. Parents see other children who are critically ill and interact with other anxious par- ents. The parents may witness the death of another child and experience the reactions of the affected family.

Stressors vary among families, and the degree of stress is influenced by factors other than the child’s hospitalization. In addition to the recovery from surgery, a particular stressor for parents of children undergoing surgery for craniosynostosis is anxiety about how the child will look after surgery. Parents need to be informed that the facial and periorbital eye swelling will increase for the first few days and then dissipate, and only then will they be able to appreciate the outcome of surgery. The first time they see their child’s head without a dressing can be alarming. The change in the head shape immediately after surgery will be marked; however, the final aesthetic outcome may take years to develop.