Patient Stories: Children's
A pioneering surgical team at Children’s Memorial Hermann Hospital uses operative microscopes for less-invasive treatment of craniosynostosis, offering infants with premature closure of one or more sutures of the skull more options than ever before.
“My husband noticed it first,” said Melisa about the ridge that developed on their daughter Cecilia’s forehead near the age of 4 months. “Our pediatrician took measurements and told us that based on his previous examinations, her head was developing at a slower rate than the rest of her body.”
Cecilia’s parents took their daughter to specialists in Houston and San Antonio but were dissatisfied with the answers they got. “The Houston surgeon diagnosed Cecilia with metopic synostosis and recommended that we wait several months – until she was a year old – when he would repair the suture using the traditional open approach,” Melisa said. “The San Antonio team could do the procedure endoscopically at a younger age but we didn’t feel comfortable with them.”
They found John Teichgraeber, M.D., who is a professor of pediatric plastic and craniofacial surgery at The University of Texas Medical School at Houston and codirector of the Texas Cleft-Craniofacial Team, which operates at Children’s Memorial Hermann Hospital, almost by accident when they sought treatment for Cecilia’s twin brother for a minor illness.
“We couldn’t get an immediate appointment with our pediatrician and instead saw one of his partners, Richard Plumb, M.D., who as it turns out, had practiced with Dr. Teichgraeber early in his career,” Melisa said. “He told us that Dr. T. does a minimal incision procedure for craniosynostosis using a microscope. We’d done a lot of online research, but we hadn’t found him because we’d narrowed our search too far. We were looking for laparoscopic surgeons. We didn’t know the microscopic procedure existed.”
The microscopic minimal incision approach to surgery results in less scarring, less blood loss, less patient discomfort and a shorter hospitalization than the traditional open corrective surgery. “With the microscope, we’re able to remove the affected sutures through very limited incisions in the scalp,” said Dr. Teichgraeber. “Surgery normally lasts one to two hours, with a hospitalization of one to two days, rather than the three to six days required for the traditional open procedure.”
Dr. Teichgraeber and his partner James Baumgartner, M.D., a pediatric neurosurgeon affiliated with Children’s Memorial Hermann Hospital and a research collaborator at the UT Medical School, use the operative microscope to correct craniosynostosis in infants who are 4 months old or younger.
“The ideal timing for surgery is before 3 months of age,” Dr. Teichgraeber said. “Chronologically, Cecilia fell within the window of opportunity because of her prematurity.” Cecilia and her twin were born at 33 weeks’ gestation.
In older children and those with multiple suture synostosis, extensive reconstruction of the craniofacial skeleton is required through an ear-to-ear incision in the scalp. The affected suture is removed, and the surrounding bones are correctly positioned using small absorbable plates and screws. Although the procedure should be done early in life, there is no upper age limit to the surgery.
Dr. Teichgraeber told Cecilia’s parents he could correct her craniosynostosis either way – microscopically or with the open surgery. But after examining their daughter, he suggested the open procedure performed at a later age would produce a better result.
“We’d read studies comparing the outcomes of both procedures performed at different ages, so we knew intellectually that waiting until Cecilia was older was not likely to result in problems,” her mother said. “But it didn’t make sense to us intuitively that there would be no repercussions if her brain didn’t have the proper space to grow.
“So we decided we didn’t want to wait. It was an agonizing decision because we didn’t know whether the microscopic procedure would be successful. We didn’t know whether she would need the open procedure when she was older. We didn’t want to put her through two surgeries.”
Cecilia’s minimal incision surgery took 40 minutes, and she left the hospital after a two-day stay. “The very next week we went for a helmet fitting,” Melisa said. “It was ready in two days. Everything was rolling along quickly, so that I never had time to catch my breath, which was good. Having a newborn with craniosynostosis is a lot to deal with, especially when you have another little one at home.”
Helmet therapy is labor intensive for parents. “It’s a huge time commitment,” she said. “You have to go every week to have the helmet reshaped. But we were very compliant. Cecilia was lucky to get one full hour a day without the helmet. We’d take it off, bathe her, clean it, let it dry and put it right back on.”
Cecilia’s surgery took place on July 25, 2006, and she wore her pink helmet with the flowers on it for five months, until early December 2006.
“We’ve met so many wonderful people through this experience,” Melisa said. “Dr. T. and Dr. B. and Ruth* pushed things along for us and made sure everything was scheduled. I can’t tell you how much we loved them for taking such good care of us. Cecilia is 2 now, and you can’t tell a thing. Dr. T. said she’s his best outcome. Her scars are almost completely covered by hair. She looks fantastic.”
To refer a patient to the Texas Cleft-Craniofacial Team, call 832.325.7234.
*Ruth Fleshman is coordinator of the Texas Cleft-Craniofacial Team.