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Open cranial vault reconstruction at North Austin Campus

Conditions

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Open cranial vault remodeling is a well-recognized technique to reconstruct or reshape a skull affected by conditions such as craniosynostosis. It is called “open” since the surgeon uses a scar known as a coronal incision to be able to see the entire skull and reshape it directly. 

Although open vault remodeling has been used for more years than other surgeries for craniosynostosis, there are continual improvements to give the best long-term results. Open cranial vault remodeling is usually used for more complex craniosynostosis such as in craniofacial syndromes, or in older children when smaller incision surgeries such as endoscopic strip craniectomy or spring cranioplasty are not effective. It is important to know that the risk of complications are the same for smaller incision surgeries as it is for open cranial vault remodeling.

  • Unlike other types of craniosynostosis repair we offer in North Austin, open cranial vault remodeling can be used for any cranial condition and at any age.
  • If a baby with craniosynostosis is young enough so that several treatment options are available, our craniofacial plastic surgeon and neurosurgeon will talk with you to explain the different approaches to help you decide which is better for your child.
  • Many families choose open cranial vault remodeling since the cranial correction is completed by the end of the surgery, and usually no further surgery or treatment is required.
  • We always recommend open cranial vault remodeling in complex conditions when we consider it more dangerous to do the surgery through smaller incisions, or when we believe other techniques will not give the same results.
  • Open cranial vault reconstruction starts by making a zig-zag cut (incision) over the top of baby’s head known as a coronal incision. The incision goes from one side of the temple to the other.
  • The craniofacial plastic surgeon separates the skin and other lining from the bone underneath and marks the pattern of bone cuts needed to reshape the bone. 
  • The pediatric neurosurgeon makes small holes in the skull. The surgeons carefully separate the coating of the brain (dura) from the bone.
  • With the neurosurgeon protecting the brain, the craniofacial surgeon makes cuts in the bone based on the pattern.
  • When the back of the head needs to be reshaped, the bone is usually gently bent into its new position with special tools without removing the bone. These are called “barrel staves” since they create a new curve to the skull like the side of a barrel. Examples of these conditions are sagittal synostosis and lambdoid synostosis.
  • When the front of the head needs to be reshaped, the surgeons will remove parts of the bone and then rebuild them into their new position using special techniques similar to carpentry. Once the new shape has been built, the surgeon will then be put back the bone and secure it with resorbable plates and screws or dissolving sutures.
  • The surgeon closes the scar with dissolving sutures and the only dressing is antibiotic ointment for 5 days. Most babies spend 3 to 5 nights in the hospital, including 1 night in the pediatric intensive care unit (PICU). 
  • After surgery, your baby's brain quickly expands into the new head shape and the bones heal in their new position. No helmet is required and no further surgeries are usually needed. 
  • We can safely perform open cranial vault remodeling at any age if needed
  • Our preferred age for open cranial vault remodeling of the back of the head, such as sagittal synostosis or lambdoid synostosis is 4 to 6 months.
  • Our preferred age for open cranial vault remodeling of the front of the head known as “fronto-orbital advancement” is 10 to 12 months. This is used for conditions such as metopic synostosis and coronal synostosis. 
  • We usually delay open fronto-orbital advancement surgery in children with complex craniofacial syndromes until closer to two years of age for a better long-standing result in these children.
  • After leaving the hospital, your child will take Tylenol, ibuprofen and a prescription pain pill. They usually only need the prescription medicine for a few days and are off all medicine by 2 weeks. 
  • You can bath your child, play with them and hold your child after surgery the same way you did before surgery. We usually only recommend avoiding unsupervised play with older children for four weeks after surgery. 
  • Infants less than 2 years old usually return to all their usual daytime play activities by two weeks after open cranial vault remodeling. Older children often take a few more weeks.
  • Sleeping routine is usually the last thing to come back after any surgery in children. We usually hear that most infants return to their pre-surgery sleep routine by three weeks.