747 52nd Street,
Location : Oakland
Zipcode : 94609
I would be happy to discuss treatment options with you. You can contact me directly via email.
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• Most experience with minimally invasive correction in the region
• Helmet Program in our office
• Craniosynostosis patients are supported by an entire craniofacial panel
In 2002, Children’s Medical Director of Neurosurgery Peter Sun, MD, became one of the first pediatric neurosurgeons in the country to perform endoscopic craniosynostosis surgery. He studied under neurosurgeon David Jimenez, MD, who, with his wife, plastic surgeon Constance Barone, MD, developed the procedure. Children’s Oakland is the only facility in northern California with extensive and long-standing experience in endoscopic craniosynostosis and skull surgery, and this procedure has not been performed on a regular basis elsewhere in the region.
“A baby’s skull is made up of several large bones connected by flexible structures called sutures,” Dr. Sun explains. “These flexible sutures allow the brain to grow. Craniosynostosis occurs when a suture is missing or closes up too soon. That causes a deformed head shape and may prevent the brain from having enough room to grow.”
Traditional surgery to correct craniosynostosis requires a long incision across the skull from ear to ear, behind the baby’s hairline. The surgeons remove major portions of the skull and rearrange the bones to achieve a normal skull shape and size. This type of surgery typically is performed when the child is 6 to 12 months old.
Endoscopic surgery for craniosynostosis involves making two small incisions and inserting tiny instruments to remove the fused suture and strips of bone. This type of surgery must be performed during the first few months of life before too much brain growth occurs, generally when the baby is about 3 months old.
“Endoscopic surgery is the optimal approach for correcting sagittal synostosis, but it must be performed at an early age when the bones are much thinner and easier to cut through,” says Children’s plastic and reconstructive surgeon Bryant Toth, MD, a care team partner in this specialized surgical procedure.
According to Dr. Sun, invasive traditional surgery may sometimes require additional revision surgeries. “Minimally invasive surgery produces better cosmetic results, has a shorter hospital stay, offers the possibility of not needing a blood transfusion and there is less chance of having to perform revision surgeries,” he says. “In the 12 years that we have been doing endoscopic craniosynostosis surgeries, we have not had to perform a single revision surgery for sagittal synostosis. It is definitely the procedure of choice in my mind. Early diagnosis is critical and makes this possible"
Dr. Sun is the Director of Neurosurgery at Benioff UCSF Children’s Hospital Oakland. Dr. Sun graduated from Columbia University Medical School, completed his neurosurgical residency at Yale University and did his pediatric neurosurgery fellowship at Children’s Hospital of Philadelphia. After 3 years as an attending physician at Children’s hospital of Philadelphia, Dr. Sun has been at Oakland since 2001. He is listed in "Best Doctors in America", Top Doctors in U. S. News and World Report and Top Surgeons by Consumer Research Council of America. Dr. Sun learned the endoscopic technique directly from Dr. Jimenez directly in 2002 and has the most experienced in California treating craniosynostosis and skull lesions with minimally endoscopic assisted invasive surgery .
Peter P. Sun MD, is a devoted and extraordinarily skilled pediatric neurosurgeon. He is committed to providing the highest quality care to his patients. He grew up in Taiwan and Los Angeles, speaks English and Mandarin Chinese, and values his bicultural heritage. Dr. Sun believes that “having another cultural background always adds more perspective.” His father and other family members came from the business world, but Dr. Sun was determined to chart his own course. “I wanted to do something where there was value beyond money.” As a child he was fascinated with the brain and nervous system. Later, as an undergraduate at the University of Southern California, he studied psychobiology, received a bachelor’s degree and went on to medical school at the Columbia University College of Physicians and Surgeons. There, Dr. Sun discovered that the nervous system was “the most elegant in the body,” and realized that the surgical approach to “fix things” was the best fit for his skills and personality. He decided to pursue neurosurgery, one of medicine’s most demanding subspecialties. Dr. Sun did a surgical internship at the University of California, Davis and completed his neurosurgical residency at Yale University. Dr. Sun then received special training at New York University, where he focused on spine surgery. Next, he did a fellowship in pediatric neurosurgery at Children’s Hospital of Philadelphia. Pediatric neurosurgery held a special attraction: “Neurosurgical conditions in kids tend to be curable…surgery on children has a lifetime impact.” Before moving to the East Bay, Dr. Sun stayed on at Children’s Hospital of Philadelphia and was Assistant Professor in Neurosurgery at the University of Pennsylvania, for four years. In 2000, Dr. Sun returned to California to become Chief of Neurosurgery at Children’s Hospital & Research Center Oakland. Dr. Sun is listed in "Best Doctors in America", Top Doctors in U. S. News and World Report and Top Surgeons by Consumer Research Council of America. Dr. Jonathan Finley, MD, the pre-eminent neuro-oncologist in the world, said of Dr. Sun: "He is perhaps the most skilled pediatric brain tumor surgeon with whom I have worked." Besides being the Director of the Brain Tumor Program at Children's Hospital of Los Angeles, Dr. Finley is a consultant at Children's Hospital Oakland. Despite being the busiest surgeon at Children's Hospital, and spending over 1500 hours a year in the operating room, Dr. Sun has found time to author or co-author numerous peer-reviewed journal articles, book chapters and lecture across the country. He’s also a Clinical Professor in Neurosurgery at the UCSF Department of Neurological Surgery, and a Pre-med Mentor at the University of California, Berkeley. Dr. Sun is double board certified in neurosurgery and pediatric neurosurgery Through the years he has developed special strengths that help him excel.
Expertise Brain tumor surgery Intra-cranial cysts Cervical instabilities Craniofacial anomaly Hydrocephalus Hydrocephalus An excessive accumulation of cerebrospinal fluid (CSF) in the brain, often causing intracranial pressure inside the skull, progressive enlargement of the head, seizures and mental retardation. Hydrocephalus is most often treated with the surgical placement of a shunt system. This system diverts the flow of CSF from a site within the central nervous system to another area of the body where it can be absorbed as part of the circulatory process. Professional Achievements Oakland Magazine Best East Bay Doctors 2007-2008 (nat'l survey) NIH National Research Fellowship Award, 1990 Professional Organizations Member, Congress of Neurological Surgeons (CNS) Member, American Association of Neurological Surgeons (AANS) Children’s Oncology Group Neurosurgery Committee - Study Coordinator, COG-9934: Systemic chemotherapy, Second look Surgery and Conformal Radiation for Infants with Medulloblastoma Member, Joint Pediatric Section CNS and AANS, member Member, International Society of Craniofacial Surgeons Western Neurosurgery Society
After a difficult delivery giving birth to her younger son Parker, Mary recalls thinking, “His head didn't look at all like his brother Brandon’s, who is three years older. When he arrived, he had a long, narrow head that was pinched on the sides. The doctor said Parker’s head shape was due to the difficult delivery.”
A month later, Mary consulted a pediatrician because Parker’s head still was not a normal shape. “The pediatrician immediately suspected a condition called craniosynostosis,” Mary says. “When the X-ray confirmed the diagnosis, she referred us to the Director of Pediatric Neurosurgery at UCSF Benioff Children’s Hospital Oakland, Dr. Sun.”
Affecting about one in 2,500 children, craniosynostosis is a condition in which the bone plates in a baby’s head fuse too early. Untreated, this can lead to excess pressure in the skull and learning disabilities, in addition to cosmetic deformity. But treatment usually involves open surgery.
“Parker had sagittal synostosis, says Dr. Sun. “In these cases, the suture that holds together the two bones that run along the top of the head fuses too early and doesn’t allow for sideways growth. The skull compensates by growing longer in the front and back, so there are bulges in the forehead and a narrow pouched-out back of the skull that looks like the keel of a boat. Besides creating an abnormal skull, sagittal synostosis presents a serious risk of pressure on the brain and subsequent brain damage. It’s important to correct the condition before too much brain growth occurs.”
Dr. Sun offered Parker’s parents two options: high precision endoscopic surgery which is a minimally invasive surgery or traditional surgery that involved opening the whole head from ear to ear. Open surgery is a four-to-six-hour operation with three to four days in intensive care. This procedure would include a long recovery time with a guaranteed blood transfusion. And Parker would also have to wait until he was 6-12 months old.
“Dr. Sun thoroughly explained our options,” says Parker’s father, Hardy. “He emphasized that endoscopic surgery needs to be done soon after birth because of possible brain damage and other potential problems. He also encouraged us to speak with the mother of another patient who had endoscopic surgery, which tilted us toward endoscopy.” Also, Children’s Oakland’s team of neurosurgeons has achieved national fame and been ranked among America’s top surgeons by Consumers’ Research Council of America. The team performs between 300 and 350 neurosurgeries each year. And Children’s Oakland is known for its post-operative care in the largest pediatric and neonatal intensive care units in Northern California.
Parker’s endoscopic surgery was performed at the age of 3½ months. All craniofacial surgery at Children's involves both a pediatric neurosurgeon and a plastic surgeon. Dr. Sun working together with Dr. Toth, director of Children’s Craniofacial Center fused suture and strips of bone with an endoscope or lighted retractor through two small incisions. Parker remained in the hospital only for a few days, compared to the much longer hospital stay required after traditional surgery. As well, a multidisciplinary panel of specialists at Children’s was there to coordinate the additional care Parker needed.
“It was scary to have a newborn go through something like this, but Children’s is a super place,” Parker’s father says. “There was a high degree of coordination among all the different specialists—the neurosurgeons, plastic surgeons, the eye doctor, the ear doctor. Even though it was emotionally tough, the people at Children’s helped get us through it.”
After endoscopic craniosynostosis surgery, the child wears a helmet that is custom-designed by an orthotist to help mold the skull into a normal shape. Then the helmet is adjusted as the child grows. “Parker wore a helmet for six months, and we took it off only for bathing,” Mary says.”
Parker, now a top student and athlete, looks great and has a normal head shape. Dr. Sun and Dr. Toth continued to monitor Parker’s development for several years. “Dr. Sun would measure my head, and always explain why,” Parker says. “I don’t have any scars that I notice, and no one notices the little bumps on my head unless I tell them.”
Marina and David Yoakum were overjoyed at the birth on July 7, 2010, of their identical twin sons, Chase and Grant. Weeks later, however, Marina and David were dismayed and alarmed to learn the boys both had a condition called craniosynostosis, which results in skull deformities and may present a serious risk of pressure on the brain and subsequent brain damage.
“I first noticed something was wrong with the shape of their heads in the first few days,” Marina recalls. “Their heads just didn’t look like their older brother Max’s head did when he was born. Plus, even though the boys are identical twins, they each had a different head shape. While they were in the hospital, I asked about the shape of their heads, and I was told not to worry about it.” When the boys’ skulls didn’t acquire more normal shapes within a couple of weeks, Marina trusted her instincts and asked their family pediatrician for her opinion.
“She shared my concerns,” Marina says. “Because she had seen this condition before, she jumped right on it and referred us to Children’s Hospital in Oakland. The hospital organized a team of experts to evaluate the boys. There is no way I could have contacted all those specialists on my own and organized the care. We had a team of doctors who closely coordinated all their efforts.”
The Children’s team of experts— headed by Medical Director of Neurosurgery Peter Sun, MD, and Director of Craniofacial Surgery Bryant Toth, MD, a plastic and reconstructive surgeon—was experienced in diagnosing craniosynostosis and performing surgical corrections. The panel of experts reviewed the boys’ cases and ordered CT scans, which confirmed that both twins had craniosynostosis—but with differences between their conditions.
“A baby’s skull is made up of several large bones connected by flexible structures called sutures,” Dr. Sun explains. “These flexible sutures allow the head and brain to grow. Craniosynostosis occurs when a suture is missing or closes up too soon. That causes a deformed head shape and may prevent the brain from having enough room to grow.”
The main sutures of the skull are the sagittal, metopic, coronal, and lamboid. The types of abnormal head shapes depend on which sutures are closed. Chase and Grant had different head shapes because different sutures had closed.
“Chase had sagittal synostosis, the most common suture to close too soon,” says Dr. Sun. “In these cases, the skull shape is typically too narrow because it doesn’t allow for sideways growth. The skull compensates by growing longer in the front and back, with a large forehead and a narrow pouched-out back of the skull that looks like the keel of a boat.
“In Grant’s case, there were two sutures involved—the sagittal and a coronal,” he continues. “His coronal suture synostosis caused a flatness of the forehead on the affected side, and the eye socket was pulled up on that side.”
Because Chase had only one suture involved, there were two options for corrective surgery: traditional invasive surgery or minimally invasive endoscopic surgery. Children’s is the only facility in northern California with extensive experience over the course of 10 years in minimally invasive endoscopic craniosynostosis surgery to correct certain types of this skull deformity. This procedure is not performed on a regular basis elsewhere in the region.
“The early diagnosis gave us the option to choose endoscopic surgery for Chase,” says Marina. “For Grant, though, the only option was traditional surgery because two sutures were involved. As one of those rare mothers who has had children go through both types of procedures, I can’t imagine not choosing endoscopy if that is an option.”
Endoscopic surgery for craniosynostosis involves making two small incisions and inserting tiny instruments to remove the fused suture and strips of bone. This type of surgery must be performed during the first few months of life before too much brain growth occurs—generally by the time the baby is about 3 months old.
Traditional craniosynostosis surgery requires a long incision across the skull from the top of one ear to the top of the other ear, behind the hairline. The surgeons remove major portions of the skull and rearrange the bones to achieve a normal skull shape and size. This type of surgery typically is performed when the child is 6 to 12 months old.
“Endoscopic surgery—which must be performed at an early age when the bones are thinner and easier to cut through— was the optimal approach for correcting Chase’s sagittal synostosis,” says Dr. Toth. “Chase’s surgery was performed on August 31, when he was nearly 2 months old. Grant’s larger, traditional surgery was performed on November 2, at age 4 months, because waiting any longer would have created a greater asymmetry of the skull and a larger deformity.”
For each of the boys’ surgeries, Marina stayed with them at Children’s for five days straight, while the other baby was home with David.
“With all the pre-surgery appointments, the actual surgeries, and the follow-up care, I felt like I lived at Children’s,” Marina admits. “I can’t say enough good things about the phenomenal care at Children’s. The people were all so tremendous, so caring.”
One of those people was pediatric craniofacial nurse Carole Reilly, RN, BSN, who works with Dr. Toth. She followed both boys’ progress in the hospital and has continued to provide follow-up care through the craniofacial team.
“I worked with the neurosurgery nurses and also would check on the boys a couple of times a day in the ICU, answering any questions Marina had,” Carole explains. “Our staff also manages all their appointments with various specialists for follow-up care such as hearing tests, speech therapy, and ophthalmology exams. The boys also had frequent follow-up exams with Dr. Toth and Dr. Sun. Now they have yearly check-ups with them, and we will follow them until adulthood.”
Marina notes, “Carole was incredible —holding the babies, playing with their older brother Max, and visiting me. It felt like she was a family member. She truly helped humanize the whole experience.”
After their surgeries, both boys wore helmets that were custom-designed by Children’s orthotist to help mold their skulls into a normal shape. The orthotist also adjusted the helmets as the boys grew.
“Both boys had to wear the helmets for about a year,” Marina notes. “Trish Collins in the helmet lab was wonderful. She even came to our home one time to deliver new helmets.”
At about 11 months old, Grant’s forehead began to bulge on one side and the eye on that side closed up. A CT scan showed that the coronal suture had closed up again, and an additional surgery was scheduled two weeks later. Dr. Sun notes that additional corrective surgeries are sometimes needed after the larger traditional surgery, while they have not had to perform any corrective surgeries on endoscopic surgery patients over the past 10 years with sagittal synostosis.
“I asked Dr. Toth if we really needed to do the second surgery on Grant,” Marina says. “He said, ‘Absolutely. If this was my child, this is what I’d want.’ I clung to that and appreciated his compassion. Dr. Sun told us, ‘Our ultimate goal with Grant is to have him go to a cocktail party as an adult and no one notices anything different about him.’ Now at age 3, Grant is just adorable. He still has some minor bumps, but no one notices.”
For Marina, sharing the story of her family’s experience is her way of helping other parents who may face the same situation.
“As devastating as this diagnosis can be, there is hope for these kids, and you do get through it,” she says. “Parents need to know that early diagnosis is critical. They also have to be aware that after surgery, the baby’s head will be swollen for awhile, and it changes the baby’s appearance. With Grant, the surgery was even more emotional for me, with the zigzag incision across the top of his head.
“The boys start preschool this fall, and they are the cutest, happiest, chattiest little boys who love each other,” she adds. “Now I feel so incredibly fortunate that we live within miles of Children’s Hospital. We are lucky to live in a time and place where these procedures are available. Dr. Toth is so sweet and kind, and he always goes the extra mile. And I just felt so confident in Dr. Sun—he really knows what he is doing. They’re the ones you would want working on your newborn child’s skull.”