PEDIATRIC NEUROSURGERY

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Does your baby have an abnormal head shape? What a question!! Mothers and fathers have plenty to worry about with a new baby. The most concerning of these worries is the health of their child. Following inspection of fingers and toes at birth, developmental milestones are anxiously monitored awaiting the first signs of personality and intelligence. Each ensuing sign of normality and excellence is rejoiced and each question of a potential problem can send waves of horror through the most rational of family members. Be reassured that most infants do have a round or normal head shape and even if the head shape is abnormal most children will have a good outcome. There are, however, two common conditions of abnormal head shape that may need medical attention and to assure desired results early identification and treatment is imperative. Craniosynostosis (premature fusion of the skull bones) is one of the most common physical deformities of newborns and occurs in about 1 of every 2,000 births. Another and more common cause of abnormal head shape has increased dramatically in the past decade. It is referred to as positional or deformational plagiocephaly. The increased incidence has occurred following the American Academy of Pediatrics (AAP) recommendation that babies sleep on their backs to reduce the risk of sudden infant death syndrome. While this recommendation may have been instrumental in saving infant lives, studies linking back sleeping and plagiocephaly have led to new AAP recommendations that parents occasionally turn a sleeping infant’s head to avoid deformation.

Craniosynostosis results from the premature closing of one or more of the sutures of bones in the skull. The particular shape of the head can help to determine whether there is craniosynostosis. In difficult cases CT scans can help determine if the abnormal skull shape is craniosynostosis, or simply a result of fetal head position or birth trauma. Children with craniosynostosis may have the following problems: Abnormal skull shape, abnormal forehead, asymmetrical eyes and or ears, elevated intracranial pressure (pressure inside the skull) which can cause delays in development or permanent brain damage if not corrected.

In mild cases, babies born with craniosynostosis do not require surgery and correction of the deformity is a choice that parents make for cosmetic reasons. In more severe cases, children may suffer with headaches, developmental delays and damaged self esteem if the deformity is not corrected. Surgery done early is easier and safer, ideally around 3 months of age. Only one surgery is usually required to separate the sutures, reshape the bones and place them in the proper position. About 10 percent of children will need a second surgery. Prior to surgery, a comprehensive CT scan may help surgeons plan the reconstruction and explain the procedure with the child’s family.

In some families, simple craniosynostosis appears to be an inherited trait caused by a genetic mutation. The likelihood that a second child will also have the condition is slim – about four percent at the highest. There is also a small chance that a child born with single suture craniosynostosis would have children with the condition. When craniosynostosis is a part of syndrome such as Crouzon Syndrome or Apert Syndrome the congenital conditions may be associated with as much as a 50 percent chance that the condition and its associated craniosynostosis will pass from parent to child.

Please contact NSPC (631) 983-8400 for more information or to schedule an appointment.