Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf skull); recontouring with multiple osteotomies and bone autografts (eg, barrel-stave procedure) (includes obtaining grafts)
CPT4 code
Name of the Procedure:
Extensive Craniectomy for Multiple Cranial Suture Craniosynostosis (e.g., Cloverleaf Skull); Recontouring with Multiple Osteotomies and Bone Autografts (e.g., Barrel-Stave Procedure) (Includes Obtaining Grafts).
Summary
This surgical procedure corrects skull malformations known as craniosynostosis, where multiple cranial sutures fuse prematurely in infants. Surgeons reshape the skull by removing parts of it (craniectomy), making precise cuts in the bone (osteotomies), and using the child's own bone (autografts) to achieve a more normal skull shape.
Purpose
The main goal is to correct skull deformities that can cause increased intracranial pressure and abnormal head shape. This procedure aims to allow for improved brain growth and development, reduce the risk of neurological complications, and achieve a more typical skull contour.
Indications
- Multiple cranial suture craniosynostosis (e.g., cloverleaf skull)
- Symptoms of increased intracranial pressure
- Abnormal head shape affecting physical appearance and potentially brain development
- Infants and young children with confirmed diagnosis through imaging and clinical examination
Preparation
- Preoperative imaging studies (CT or MRI scans)
- Blood tests and overall health assessment
- Fasting instructions prior to surgery day
- Possible adjustments to medication regimen
Procedure Description
- Anesthesia: The patient is given general anesthesia to ensure they are completely unconscious and pain-free.
- Incision: A surgical incision is made over the scalp.
- Craniectomy: Portions of the skull are carefully removed.
- Osteotomies: The remaining bone is cut strategically to allow reshaping.
- Recontouring: The surgeon repositions and contours the bone fragments to create a normal skull shape.
- Bone Grafts: Bone pieces (autografts) taken from the patient are used to fill gaps and stabilize the new skull shape.
- Closure: The scalp is closed with sutures or staples.
Specialized surgical tools, including saws and fixation devices, are used throughout the procedure.
Duration
The procedure typically takes 4 to 8 hours, depending on the complexity and extent of the skull deformities.
Setting
This procedure is performed in a hospital setting within an operating room that has specialized surgical and anesthesia equipment.
Personnel
- Pediatric neurosurgeon
- Craniofacial plastic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding or blood clots
- Brain swelling
- Complications from anesthesia
- Scarring
- Need for additional surgeries
- Delayed healing or issues with bone grafts
Benefits
- Reduction of intracranial pressure
- Improved brain growth and cognitive development
- Enhanced skull appearance
- Prevention of long-term neurological complications Benefits might be noticed gradually as the child grows and develops.
Recovery
- Hospital stay of several days to monitor recovery
- Pain management with medications
- Head dressings and/or special helmets to protect the new skull shape
- Follow-up appointments to track healing and development
- Full recovery typically takes several weeks to months
Alternatives
- Less invasive procedures (e.g., endoscopic-assisted craniectomy) for less severe cases
- Conservative management (e.g., helmet therapy) for milder forms of craniosynostosis Pros and cons of alternatives include differences in invasiveness, recovery time, and the extent of correction achievable.
Patient Experience
During the procedure, the patient will be under general anesthesia and not feel anything. Postoperatively, the patient may have swelling, bruising, and discomfort, which is managed with pain relief measures. The medical team provides support for a smooth recovery and encourages parents to closely follow post-operative care instructions.