Inside Pediatrics Winter 2021

PIONEERING SURGERY SPARES INFANTS FROM HELMETS

T he Cleft and Craniofacial Center at Children’s of Alabama is one of the busiest in the country with some of the most experienced physicians and support staff. From cleft palate to craniosynostosis (a condition in which the skull fuses too early) and complex tumor surgeries, the center draws patients from the entire Southeast region and beyond. It is a truly multidisciplinary group with neurologists, neurosurgeons, plastic surgeons and a craniofacial pediatrician. It also offers state-of-the art therapies, including a new type of endoscopic surgery for craniosynostosis in infants as young as three months that is only performed in a few centers in the U.S. “The typical procedure is an endoscopic release of the craniosynostosis followed by post-operative helmet therapy,” said neurosurgeon James M. Johnston, M.D. “Helmet therapy works well, but kids have to wear it for 23 hours a day, and that can be a lot of work for families, especially when they live far from Birmingham,” he said. In addition, the Alabama Medicaid program, which covers most of these children, does not pay for the helmets, which can cost thousands of dollars (and children often need more than one). This puts tremendous financial strain on many families.

So Dr. Johnston, joined by neurosurgeon Curtis J. Rozzelle, M.D. and plastic surgeons René P. Myers, M.D. and John Grant, M.D., brought spring-mediated cranioplasty, which was developed at Wake Forest University, to Children’s. It starts with the same endoscopic craniectomy used for children who would require helmets. Only in this procedure, the plastic surgeon steps in and inserts custom-made springs into the bony defect created by the surgery. The springs work to expand the skull over several months to correct the abnormal head shape and ensure appropriate cranial volume for brain growth. A few months later, the plastic surgeon removes the springs during a same-day surgery. “What’s nice is that there’s no need for a helmet,” Dr. Johnston said. Plus, studies show the procedure is just as safe and effective as cranioplasties requiring helmets.¹ It’s also covered by all health insurance. “So, we’re able to do it for all children,” he said. A similar procedure using cranial distractors, like those used to lengthen femurs, is used for skull expansion, explained Dr. Grant. This technology is used in older children who need more intracranial volume but who are beyond the age at

Custom-made springs expand the skull over several months to correct an abnormal head shape and ensure appropriate cranial volume for brain growth. A few months later, plastic surgeons remove the springs during a same-day surgery.

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