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Cranial vault surgery – how to prepare fact sheet

How to prepare for cranial vault surgery

What is a craniosynostosis?

Craniosynostosis is a birth defect in which one or more of the fibrous joints between the bones of your baby’s skull (cranial sutures) close prematurely (fuse), before your baby’s brain is fully formed. Brain growth continues, giving your baby’s head a misshapen appearance.

Craniosynostosis usually involves fusion of a single cranial suture, but can involve more than one of the sutures in your baby’s skull (complex craniosynostosis). In rare cases, craniosynostosis is caused by certain genetic syndromes (syndromic craniosynostosis).

How is a craniosynostosis treated?

Treating craniosynostosis involves cranial vault surgery to correct the shape of your baby’s head and allow for normal brain growth. Early diagnosis and treatment allow your baby’s brain adequate space to grow and develop.

Although neurological damage can occur in severe cases, most children have normal cognitive development and achieve good cosmetic results after surgery. Early diagnosis and treatment are vital.

Admission procedures

  1. You will receive notification of the admission time, ward and procedure details once a date is allocated for your child’s surgery. In most cases, children undergoing cranial surgery will be admitted to hospital on the day of surgery.
  2. Your child will require a blood test after they are admitted to the ward. This will be performed on Level 3 (go to the Pathology desk outside 3B) at 7.30am unless notified otherwise by the clinical nurse.
  3. Your child will then have a nursing admission completed and you’ll meet with the anaesthetic doctor and one of the doctors from the plastic and reconstructive team.
  4. Your child will be called for theatre and you’ll be taken to the theatre waiting area. The procedure may take up to six hours and this includes the anaesthetic, operation and time spent in the recovery room.

Length of stay

Your child will stay in hospital for five to seven days following cranial vault surgery. The first night will be spent in the Paediatric Intensive Care Unit (PICU) where your child will be closely monitored as a routine precaution.

If your child remains stable, they will be transferred to a ward the next day, where they will stay until cleared for discharge. If you don’t live in Brisbane, it’s recommended that you stay in the area for one week to enable your child to be reviewed at the clinic.

Pain relief

Your child will be on a pain-relief intravenous drip for the first three days after the operation. This will be managed by a specialist team of doctors and nurses who will review your child daily. The pain relief may make your child sleepy and nauseated. Your child may also vomit in the first few days after the operation. Once the drip stops, the pain team will normal prescribe strong oral pain relief medication which can be given as needed.

Fluids

Your child can eat and drink as they wish. They will receive fluids via a drip to keep them hydrated until they are drinking an adequate amount of fluids.

Bandages and drains

Your child will have a bandage (sometimes referred to as a “head bundle”) around their head after the surgery. Your child may also have one or two drains attached to their wound to drain away excess fluid after the operation. The bandage and drains will be removed after two to three days.

Swelling

Children will have various levels of swelling in their face and scalp following this operation. Their eyelids will progressively swell over the first four days and often completely close around day two or three. The eyes will then gradually open from day four onwards. The overall swelling will usually subside over a week or more, although this varies for all patients. Please contact the Cleft and Craniofacial Surgery clinical nurse if you are concerned regarding this.

Wound care

Your child’s wound will require monitoring and care. You will be provided with information on how to care for the wound while you are in hospital and what to do if you are concerned. You will see a doctor approximately one to two weeks after discharge, who will review the wound. The craniofacial nurse can be contacted during business hours if you have any concerns at any time after the surgery.

Although extra care to avoid head bumps is recommended for four weeks, no helmet protection is required. The skull is close to normal strength within six to eight weeks.

Discharge

The criteria for discharge include:

  • Your child is eating and drinking adequate amounts to maintain hydration.
  • Your child’s pain is managed with medication taken orally.
  • Your child’s eyes are no longer closed shut from the swelling.
  • Your child’s temperature is within normal range.
  • Your child will usually be discharged five to seven days after the operation.

Follow-ups needed after the operation

One to two weeks – review in Outpatients Department

Two to six months – further reviews.

Annual and two-yearly – reviews at the Craniofacial Clinic.

Regular follow-ups ensure your child’s skull growth continues, corrected head shape is maintained and development progresses appropriately.

Contact us

Clinical nurse, Cleft and Craniofacial Surgery
Lady Cilento Children’s Hospital
501 Stanley Street, South Brisbane 4101
t: 07 3068 4321 (business hours)
t: 07 3068 1111 (general enquiries – ask for plastic surgery registrar on call)

If you have any concerns about your child once they’re home, please phone the Neurosurgery Clinical Nurse Consultant on 3068 1384.

In an emergency, always contact 000 for immediate assistance.

Resource No: FS286. Developed by the Plastics and Reconstructive Surgery Department, Lady Cilento Children’s Hospital. Updated: January 2018. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.

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