Surgical Team Reconstructs Infant’s Cranium
Ryan Burke, 8 months, underwent reconstructive neurosurgery at Children’s Memorial Hermann Hospital this summer to fix fused plates in his skull.
By Alexandra Seifert | Children’s Memorial Hermann Hospital
When Ryan Burke was born eight months ago in Chicago to Leah and Jason Burke, the first-time parents noticed that their son’s head was a little lopsided. But medical staff reassured the couple that this was most likely a normal consequence of being pushed through the birthing canal, and that it should resolve naturally. After three months, however, the lopsidedness had progressed, and the family’s pediatrician decided to refer them to a neurosurgeon in Chicago.
It was there that Ryan was diagnosed with a rare form of craniosynostosis called Lambdoid synostosis. Lambdoid synostosis involves the premature closure of the lambdoid suture, which is the joint that runs across the skull near the back of the head. It can result in a flattening of the infant’s head on the affected side, and in Ryan’s case, it caused his ears to look more and more lopsided as his brain grew.
The word craniosynostosis is defined by the sum of its parts: it comes from the fusing of the words cranio, derived from cranium, meaning the skull; syn, a prefix which means together; and ostosis, which describes the formation of bone. Our bodies, from our cells to our lungs to our ligaments, are all dictated by the smaller components that combine to make the whole. It’s a predictable pattern, but when one element becomes abnormal, the whole mechanism is affected.
Craniosynostosis describes one such example: it is defined as the premature closure of one or more of the joints between the bones of the skull. The joints, called sutures, permit small amounts of movement in the skull, allowing for slight elasticity and growth, which is crucial for a developing baby’s brain. In craniosynostosis, the sutures ossify, or harden into bone, earlier than they should, thereby altering the normal growth pattern of the infant’s skull. Because the skull cannot expand in the area of the fused sutures, it compensates by growing in a different direction. The resulting growth pattern may not allow enough space for a growing brain and can result in abnormal head shape or facial features as the infant develops. Varying degrees of visual impairment, sleep impairment, eating difficulties, or impaired mental development are all possible consequences of this condition. The consensus among the medical community is that there are three to five cases of craniosynostosis for every 10,000 live births.
“There are textbook cases of craniosynostosis and then there are the very rare cases,” said David Sandberg, M.D., pediatric neurosurgeon at Children’s Memorial Hermann Hospital. “Ryan Burke was born with one of the rarest forms of the condition.”
Surgery is the primary treatment for craniosynostosis. It requires an incision in the infant’s scalp and cranial bones, where the affected suture or sutures are removed, and then the surrounding bones are reformed and placed into the correct position. The intention is to relieve pressure on the brain and create more room for the brain to grow.
“We were in shock,” Leah said. “It took a while to come to terms with the fact that our baby would require this surgery.”
She and her husband set out to find the best craniofacial neurosurgery team in the country to work on Ryan, finally choosing Drs. David Sandberg and John Teichgraeber at Children’s Memorial Hermann Hospital.
“They were personally recommended to us, and when we came to Houston to meet them, we knew immediately that they would provide the best care for our son. Not only do they have the credentials and the experience to treat Ryan’s rare form, but they are both just wonderful human beings – a lot of doctors are not always the most personable or thoughtful, but Dr. Sandberg and Dr. T proved that to be untrue. They were extremely patient with us, very understanding, and willing to explain things a hundred times,” said Leah.
The surgery took place this June, and required Ryan to go under full anesthesia for four hours. Sandberg, who is also director of pediatric neurosurgery at the Mischer Neuroscience Institute at Memorial Hermann-Texas Medical Center, and associate professor of neurosurgery and pediatric surgery at The University of Texas Medical School at Houston, performed the neurosurgery part of the procedure, which involved carefully cutting and removing the fused sutures in the skull.
Teichgraeber, who is a professor and co-director of UT Medical School’s Texas Cleft-Craniofacial Clinic and a pediatric craniofacial surgeon at Children’s Memorial Hermann Hospital, worked as the “artist” on the team. His job was to recut and re-contour the bones to normalize the side that was affected by the sutured fusion. Once the bones were reshaped, he repositioned them so they would resume normal growth and development. The pieces were secured in place with tiny plastic plates and screws that absorb naturally after about a year.
“We’re basically carpenters for the skull. The joke is that the neurosurgeons take it apart and the craniofacial surgeons put it back together,” said Teichgraeber. “But really, we work as a team the entire time to provide the best care possible for the child, from his health and functionality to the aesthetic aspect of reshaping his bone structure.”
The surgery was successful and Ryan is already on his way to a full recovery.
“Ryan will wear a cranial helmet for three months to reinforce Dr. Teichgraeber’s work, and he will have a few scars on his head from where we made the incision, but those will be covered once his hair grows in. So far his progress has been outstanding, and at this point we expect him to resume completely normal development,” said Sandberg.
Ryan is now 8 months old and, according to Leah, reaching all of his developmental milestones.
“We couldn’t be happier with the surgery and all of the care we’ve received since. Ryan had a rough few weeks immediately following the surgery, but he has completely rebounded and is back to just being our wonderful little boy.”