STORY BYIt's scary enough to learn that your infant has been diagnosed with craniosynostosis, a birth defect in which the skull fuses prematurely, hindering growth of the brain.
It's even worse when you learn about the traditional procedure to correct it, a surgery in which the skin must be peeled down the child's face and the skull bones rearranged with an assortment of plates and screws.
But a new less-invasive, microscopic surgery pioneered and honed by surgeons at the University of Texas Medical School at Houston has given parents of infants such as Elyssa Turner and Sabrina Goins a far better option.
Pediatric surgeon James Baumgartner demonstrates where the small piece of skull is removed to allow the brain more room to grow.
James Baumgartner, M.D., assistant professor of pediatric surgery, and John Teichgraeber, M.D., professor of pediatrics, have tracked 30 children who underwent the new procedure. They found the less-invasive technique, in combination with a molding helmet, resulted in less trauma, less hospital time, less blood loss and better overall correction.
And it can be done earlier, before three months of age when the damage to the shape of the head is less pronounced.
“With the traditional surgery, you have to wait for the child to be four to six months old when the bone is strong enough to maintain the head shape,” Baumgartner says. “The helmet allows us to do the new surgery at a younger age when they need less correction.”
In the less invasive surgery, performed at Memorial Hermann Children's Hospital, Baumgartner and Teichgraeber create several small incisions in the skin of the skull. Using a microscope and a saw, Baumgartner intricately drills out a small piece of bone along the suture line and removes it through one of the incisions.
“It's safer, quicker and cheaper with better outcomes. It's easier on the child and the parents. This is a home run,” Baumgartner says. Overall, a child stays one to two nights in the hospital after the new procedure, compared to five nights for the traditional one.
Elyssa Turner was two months old when her alert Baytown pediatrician diagnosed her with premature closure of the skull sutures, the fibrous joints between the bones of the skull. Craniosynostosis occurs in one of every 5,000 newborns. Left untreated, it leads to mental retardation, seizures and blindness.
“My husband (Eric) and I had never heard of craniosynostosis before and the things I found on the Internet were scary,” Elena Turner says. “A friend of mine told me about Dr. Teichgraeber. We were nervous and worried, but he told us that it was more common than we thought. When we learned about the new procedure, it was a big relief.”
Mom B.J. Goins of Round Rock, Texas became concerned when she saw a ridge on the back of Sabrina's head, but the pediatrician didn't think anything was wrong.
“We had to figure it out ourselves,” Goins says. “Every week it seemed like her head was growing backwards and then started to push forward. It didn't seem right. I got on line and looked up abnormal head shapes. I saw the profile of a baby with the same problem and I took the information to the pediatrician.”
Goins also found the UT surgical team on-line and called immediately to make an appointment for Sabrina, who was then two months old.
“Before the surgery, she hardly ever smiled. Her face just had the saddest look. I think she may have been suffering from headaches,” Goins says. “She smiled and laughed a week after the surgery and she's a goofball now. I think there was so much pressure relieved.”
A critical part of the new surgery is the molding helmet, which protects the head and gradually shapes the skull. Two weeks after the minimally invasive surgery, the child is fitted with the helmet, lined with soft foam plastic. Molded from the child's head, it comes in two halves bridged by rubber bands that are adjusted two to four times a month as the skull grows.
The helmet is worn for 23 hours a day for two to three months. The only drawback is that it must be cleaned daily to avoid a buildup of bacteria.
“She's been doing really well with the helmet. It doesn't seem to bother her,” says Turner a few weeks after Elyssa had the surgery in February.
Goins says fitting the helmet was stressful for Sabrina but the results a year after the surgery have been great. “She's got a beautiful head now,” brags Goins, a freelance photographer who took photographs of the experience.
Baumgartner and Teichgraeber have documented their work using a cephalic index to measure how close the head has reached a normal shape. Their research so far, which includes 30 cases using the new technique over the past two years, has proven that it gives a better end result.
“With the traditional surgery, you never get 100 percent correction,” Baumgartner explains. “The new technique using the helmet results in a normal shape.”
The Turners could tell a difference immediately as Elyssa's brain, freed from the fused bone, began to fill the skull correctly.
“Her head looked normal to us just a few days after the surgery. It seemed so amazing they could do that.”
UPDATED: 5-17-2005
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Dr. James Baumgartner is an assistant professor in the Division of Pediatric Surgery at UT Medical School.
See Dr. Baumgartner also at:
Dr. John Teichgraeber is a professor of plastic surgery at the UT Medical School.
See Dr. Teichgraeber also at:
Tetanus booster for adults
Tetanus does not result from the rusty nail or whatever created the wound. The danger lies in the bacteria Clostridium tetani that lives in the soil or manure on that nail or gardening tool. When these spores get into a wound—deep or shallow—they can produce a potent toxin. Also called lockjaw, tetanus seriously affects the central nervous system and can be fatal.
Onset of symptoms can occur anytime from three days to three weeks. Call your health care provider if you have an open wound, particularly if:
Adults should have a tetanus booster shot every 10 years, known as the Td vaccine. It is a "2-in-1" vaccine that protects against tetanus and diphtheria. It contains a slightly different dose of diphtheria vaccine than what you received as a child. It can be given to anyone older than 7 years and is injected, usually into the arm.
Instead of the standard Td booster every 10 years, adults between the ages of 19 and 65 should receive Tdap one time in their adulthood to boost the immune system for pertussis, as well as tetanus and diphtheria.
Diphtheria, a contagious bacterial infection created that causes severe inflammation of the throat and larynx and can also affect the whole body. Pertussis or “whooping cough” is a serious bacterial infection that afflicted children and infants before vaccines were available. Adults may be infected later in life as their immunities wane. Neither of these infections are related to tetanus, but both vaccines are compatible and convenient to use with the tetanus booster.
