61557 Craniotomy for craniosynostosis; bifrontal bone flap

Name of the Procedure:

Craniotomy for craniosynostosis; bifrontal bone flap

Summary

A craniotomy for craniosynostosis with a bifrontal bone flap is a surgical procedure to correct a birth defect in which one or more of the sutures in a baby's skull close prematurely. This surgery involves removing a portion of the skull (bifrontal bone flap) to allow for the reshaping of the head and proper brain growth.

Purpose

Craniosynostosis is the condition addressed, where the early closure of skull sutures can lead to abnormal head shape and potential developmental issues. The goal of the procedure is to correct the skull shape, allow normal brain growth, and prevent any associated neurological complications.

Indications

• Abnormal head shape due to premature suture closure
• Increased intracranial pressure
• Associated developmental delays or neurological issues
• Cosmetic concerns for head symmetry and shape

Preparation

• Fasting for a certain period before surgery, typically 6 hours
• Stopping certain medications as advised by the surgeon
• Undergoing pre-operative imaging studies like CT or MRI scans
• Complete blood work and physical examination to assess overall health

Procedure Description

1. The patient is placed under general anesthesia.
2. A scalp incision is made, and the skin and soft tissues are carefully lifted.
3. A bifrontal bone flap is created by removing a section of the frontal part of the skull.
4. The underlying dura (brain covering) is protected while the bones are reshaped.
5. The bone pieces may be fixed back with specialized plates and screws.
6. Once the reshaping is complete, the scalp is repositioned and sutured closed.

Tools and Equipment: Surgical scalpels, bone saw, retractors, specialized plates and screws
Anesthesia: General anesthesia to ensure the patient is unconscious and pain-free

Duration

The procedure typically takes 3 to 6 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Pediatric neurosurgeon
• Pediatric anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Bleeding
• Infection
• Swelling or fluid accumulation
• Damage to brain tissues or nerves
• Problems with anesthesia
• Recurrence of craniosynostosis

Benefits

• Corrected skull shape
• Alleviation of increased intracranial pressure
• Improved neurological development and function
• Enhanced cosmetic appearance Improvements are often seen immediately, but full benefits may be realized over several months as healing progresses.

Recovery

• Hospital stay of approximately 3 to 7 days
• Post-operative care includes pain management, monitoring for signs of infection or complications, and keeping the head elevated.
• Full recovery may take several weeks to a few months
• Follow-up appointments for monitoring head shape and development

Alternatives

• Helmet therapy in very mild cases (limited success with more severe forms)
• Minimally invasive endoscopic surgery (suitable only for specific cases and usually requires post-operative helmet therapy)
• Non-surgical monitoring if no functional issues are present (may not address cosmetic concerns)

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. After the surgery, the patient may experience some discomfort, swelling, and bruising, which are managed with medications and supportive care. Regular follow-up is essential to ensure proper healing and development.