Open Cranial Vault Remodeling

What is Open Cranial Vault Remodeling?

Open cranial vault remodeling is one of the oldest and most common procedures used to treat craniosynostosis. The key feature of this type of surgery is that it requires complete removal of the skull bones from the outer covering of the brain in order to remodel or reshape the head in the area of deformity. 

What are the risks of Open Cranial Vault Remodeling?

When the bone is completely removed it also removes the blood supply from the bones. This may affect the growth of the bone and slightly increases the risk of infection when compared to procedures that leave the bones attached to the outer covering of the brain, such as extended strip craniectomy.

Open cranial vault surgeries also take longer because there is more work required in reshaping and fixing of the skull bones into their new positions. Most patients require a blood transfusion.

What can I expect with Open Cranial Vault Remodeling?

Open cranial vault remodeling is typically performed between 6-12 months of age. This is the time period when the bones are still flexible enough that they can be easily reshaped by hand but they are also strong enough to hold the resorbable plates and screws The goal is to place the bones in a position that will provide an even appearance to the skull and face a child is fully grown.

The goal of early surgery (between 6-12 months of age) is to protect the brain, the airway and the eyes. Usually, the first surgery is to reshape the skull and to increase the space inside to give the brain room to grow into.

The main goal of open cranial vault remodeling is to over-correct the skull to treat or to reduce the risk of developing increased pressure in the skull. This allows the brain to grow and improves head shape. While the ultimate goal is to normalize the head shape and overall appearance, patients with syndromic craniosynostosis  have permanent impairments in growth of the skull and facial bones. So even if we overcorrect the position of the skull bones, the patient will often outgrow the repair and require another skull expansion. The amount of overcorrection we can achieve is limited by the amount that the scalp will allow.