Montgomery’s Head Shape Corrected with Minimally Invasive Procedure

November 03, 2020

No parent wants to hear that their baby needs surgery, especially when the child is only 7 weeks old.

But in the case of Montgomery, his parents Jenn and Brad knew a procedure for their newborn would give him the best chance of correcting his misshapen head, allowing his brain to grow and develop normally.

Montgomery, Monte for short, was born with craniosynostosis, a congenital condition in which a suture or joint between the calvarial bones in a child’s skull closes too early, which doesn’t allow for proper growth of the skull. In Monte’s case, he was diagnosed with sagittal craniosynostosis, which is the most common type of craniosynostosis. The sagittal suture runs from the front to the back of the head, and so early fusion makes the head grow long and narrow.

Plastic and reconstructive surgery and neurosurgery collaborate

Experts in plastic and reconstructive surgery and neurosurgery at Ann & Robert H. Lurie Children’s Hospital of Chicago offer a minimally invasive procedure, an endoscopic strip craniectomy, for some families whose babies are born with this type of condition.

The minimally invasive procedure is an alternative to a more traditional open calvarial remodeling surgery to reshape the bones of the skull and can be successfully used for infants up to five months of age, said Noopur Gangopadhyay, MD, a plastic and reconstructive surgeon who specializes in craniofacial surgery and microsurgery. This endoscopic strip craniectomy often means a shorter stay in the hospital for families, smaller incisions, less blood loss, and a shorter operative time than the traditional open surgery.

Because Monte’s condition was discovered so early, thanks in part to an attentive pediatrician who referred the family to Lurie Children’s, the baby was a candidate for the minimally invasive operation.

“While the diagnosis was initially devastating and overwhelming, it was incredible to know Lurie Children’s surgeons could do the endoscopic procedure so soon,” said Jenn, Monte’s mom.

Dr. Gangopadhyay and Arthur DiPatri, MD, a renowned pediatric neurosurgeon, collaborated for the 90-minute-hour procedure. Together, they made small cuts on the baby’s scalp to separate the skin and tissue over the bone. Dr. DiPatri ensured the brain was protected when he made holes in the skull to separate bone from the dural covering of the brain. Together the surgeons removed the fused sagittal suture on the top of the head. This leaves the baby with a gap in the bone.

As the baby grows, the dural covering of the brain will induce new bone growth. The gap in the bone will fill in over time, creating a normal head shape and room for the brain to grow adequately.

Incisions are closed with absorbable stitches. Often, babies who get this surgery stay only one night in the hospital. That was the case for Monte, who was back to his normal routine the next day.

“Drs. Gangopadhyay and DiPatri had extraordinary bedside manner,” Jenn said. “They were helpful at every step of the way, answering all our questions. Both were extremely comforting to me and to Montgomery.”

Monte Before Surgery

Monte After Surgery

‘Couldn’t have asked for a better situation’

Babies who undergo an endoscopic strip craniectomy require several months of postoperative helmet therapy to ensure a normalized head shape. Infants are scanned for a custom helmet a few days before the surgery.  About a week after his procedure, Monte was fitted with this molding helmet by the Lurie Children’s Orthotics team.

Monte wore the helmet at all times, except for when it was removed for daily cleanings. Lurie Children’s orthotist Sarah Sawers, CO, LO, adjusted the helmet at appointments about every two weeks as the baby’s head grew. He was able to stop wearing the helmet after about eight months.

“It was a lot of work, and it got very tiring to work around it and keep it clean, but we knew it would be worth the effort,” Jenn said.

Now one-and-a-half, Monte is meeting milestones on time and a ball of energy who loves to color and chase the family’s dog, Smitty.

“He looks wonderful,” Jenn said. “He’s really, truly a gift. We were very scared at first but wouldn’t have asked for a better outcome.”