Extended Strip Craniectomy with Helmet Therapy

This procedure is primarily used to treat sagittal suture craniosynostosis, however it can also be used to treat other closed sutures. In sagittal suture craniosynostosis, the skull is long and narrow from front to back. An extended strip craniectomy uses two incisions of about an inch and a half width in the scalp to see the skull bones. Through these incisions, a wide strip of skull, including the closed sagittal suture, is removed. Cuts are made in the bone just behind the coronal sutures and just in front of the lambdoid sutures. This allows the skull bones to hinge away from one another and widen like a clamshell opening.

The ideal age for this procedure is age 3-4 months. Patients with sagittal suture craniosynostosis (scaphocephaly) diagnosed older than four months of age are too old for extended strip craniectomy surgery. This is because after 4 months of age the skull bones quickly become too thick and stiff for sufficient reshaping with the helmet. Most often, we will use an open cranial vault remodeling for these patients.

Infants’ bones heal rapidly and new bone grows, even though a large gap is made in the top of the skull with this surgery. The bone gap is created to give the brain enough time to reshape the skull before the bone heals.

After surgery, we place the baby in a custom-fit molding helmet. This helmet fits up against the forehead and back of the head and does not apply pressure. Instead, it resists growth in these directions. The skull then grows to a more normal shape because the brain takes the path of least resistance and widens pushing the bones as it expands.

A specially trained professional will adjust the helmet regularly to allow for growth. We typically keep our patients in the helmet until 18 months of age.