The Day of Surgery
The Perianesthesia staff greets you upon arrival. Your child is weighed and asked to change into a hospital gown. We also check temperature, pulse and blood pressure. A child life specialist helps your child feel more at ease with toys, crafts or movies.
Next, you and your child meet with the craniosynostosis surgery team: the operating room nurses, the craniofacial surgeon, the neurosurgeon, the nurse anesthetist and the anesthesiologist. This is time for you to raise any questions or concerns—the anesthesiologist discusses how anesthesia and pain medication are used during surgery.
First, the anesthesiologist puts your baby under anesthesia using a mask. Once your child is asleep, we start an IV, insert a breathing tube and start an arterial line in the wrist to monitor blood pressure during and after surgery. Your child might also receive a catheter in the bladder while under anesthesia.
Immediately before surgery, the surgical team gives your baby tranexamic acid, which minimizes blood loss during operations. We also give a saline solution to dilute the blood so that when bleeding occurs, your child loses a smaller percentage of their actual blood.
Craniosynostosis surgery usually lasts one to two hours and can include these steps:
- The surgical team injects your baby’s scalp with an anesthetic and a hormone commonly called adrenaline to constrict the blood vessels in the scalp and minimize blood loss.
- The craniofacial surgeon makes a wavy “stealth” incision using a special disposable blade, which uses radio frequencies to cauterize the blood as it cuts. This type of incision makes sure the hair won’t part along a straight line scar in the future.
- In cases of sagittal craniosynostosis, the surgeon performs a strip craniectomy and the bone is reshaped within the skull.
- In other forms of synostosis, the surgeon removes a section of fused skull, reshapes it and replaces it in your baby’s skull.
- The surgeon positions the reshaped bones using resorbable materials, which dissolve over the next nine to 14 months.
Resorbable materials benefit your child during surgery, because their use increases the surgical team’s speed and efficiency. The less time it takes for the surgery, the greater the likelihood your child won’t need a transfusion. Typically 90 percent of babies having craniosynostosis surgery need a transfusion. But because of a groundbreaking technique developed by craniofacial specialists at Gillette, babies having craniosynostosis surgery at Gillette rarely requires a blood transfusion. Without a blood transfusion, your child avoids the risk of bloodborne pathogens, transfusion reactions and fevers that extend hospitalization.
Immediately After Craniosynostosis Surgery
After the craniosynostosis surgery is complete, you meet with the surgeon to discuss the procedure. Soon after that, you join your baby in the Pediatric Intensive Care Unit (PICU). Usually, babies are sleepy and their eyes are swollen shut.
Your child might be wearing some items to help protect them from bothering the surgical sites, including arm restraints, which will come off once your child is awake and alert and/or a turban dressing on their head. Your child might have multiple IVs, or in rare cases, a drain in their scalp to remove excess fluid that isn’t initially absorbed after surgery.
Your baby will likely return to regular feeding habits quickly, either by the time they leave the hospital or as soon as they are able.
During the Remainder of the Hospital Stay
Your child will remain in the PICU overnight until stable enough to go to a general care unit—usually the day after surgery.
Care team members visit your child each day during the hospital stay and you’ll get daily updates about your baby’s condition.
Most children are released from the hospital three to four days after surgery. Before you go home, we’ll answer your questions and give you detailed instructions to care for your baby once you get home.