Most of the cases seen at Mayo are sagittal craniosynostosis, the most prevalent type. Patients are generally referred by pediatricians after a well-child visit. Although there is no upper age limit for referral, the optimal time is between 1 and 2 months of age. Up to age 6 months, patients with all types of single-suture craniosynostosis — sagittal, metopic, coronal and lambdoid — may be candidates for endoscopic surgery. After that, however, open surgery is generally required.
"Early diagnosis and treatment facilitate the brain's normal growth and reshaping of the head into the appropriate configuration," Dr. Wetjen says. "With referral we also can offer the option of endoscopic surgery and make sure patients are receiving care tailored to their needs."
Both endoscopic and open procedures generally produce very good cosmetic results with low risk of complications. However, compared with an open procedure, endoscopic surgery has a lower rate of complications, requires only a one-night hospital stay and has a patient-transfusion rate of just 10 percent. After endoscopic surgery, children must wear a series of two to three helmets for up to a year. "Each helmet has a significant cost, but the overall cost of endoscopic surgery is still less than open surgery," Dr. Wetjen notes.
Open surgery lasts two to three hours and requires a three- or four-day hospital stay. Transfusion also is necessary in all open cases, although no helmet is required afterward. "In open surgery, we fix the skull in position with plates and screws that are absorbable. It's a one-time procedure that requires less follow-up than endoscopic surgery," Dr. Wetjen says.
For parents whose children qualify for either endoscopic or open surgery, Mayo specialists outline the pros and cons and let the parents decide. "We try to present a balanced view because when the patient presents at a young age, either endoscopic or open surgery can be appropriate," Dr. Wetjen says.
At Mayo Clinic's campus in Minnesota, highly skilled experts in the Cleft and Craniofacial Clinic include a variety of specialists with pediatric expertise in neurosurgery, plastic and reconstructive surgery, genetic and hereditary conditions (clinical genomics), and pediatric rehabilitation. The collaborative team of experts involved depends on each child's needs. Children requiring hospitalization are cared for at Mayo Eugenio Litta Children's Hospital. Each year, doctors at Mayo Clinic, diagnose and treat about 400 babies with craniosynostosis or other craniofacial disorders. Specialists treat all types of craniosynostosis, ranging from severe syndromes to simple fusions. The campus in Minnesota is one of the few centers in the world that offers virtual surgical planning for treatment of craniosynostosis. Based on that virtual surgical plan, Mayo Clinic surgeons can customize the procedure for craniosynostosis to the individual patient with a high degree of detail. Mayo Clinic's highly skilled doctors and surgeons have significant expertise and experience with all types of craniosynostosis. Mayo Clinic in Rochester, Minn., ranks No. 1 for neurology and neurosurgery in the U.S. News & World Report Best Hospitals rankings.
Mayo is one of the few centers in the world that offers virtual surgical planning for treatment of craniosynostosis. In virtual surgical planning, high-definition 3-D CT scans of the patient's skull are sent to a device manufacturer. Engineers at the company consult via Web conference with Dr. Wetjen and Samir Mardini, M.D., a plastic surgeon in Mayo's Cleft and Craniofacial Clinic.
During the meeting the CT data are used to construct a computer-simulated, individualized surgical plan. Based on that virtual surgical plan, patient-specific templates are constructed to guide the Mayo surgeons during the procedure. "In the past, there has been a standard surgical procedure for sagittal craniosynostosis. These templates allow us to customize the procedure to the individual patient, with a high degree of detail," Dr. Wetjen says.