Developing technologies to improve the treatment of craniosynostosis in children

Engineers and surgeons are working together to improve the treatment of babies born with craniosynostosis, a condition that causes the bone plates in the skull to fuse too soon. Treating this condition typically requires surgery after birth to remove portions of the fused skull bones, and in some cases the bones grow together again too quickly - requiring additional surgeries.

Researchers in the Atlanta-based Center for Pediatric Healthcare Technology Innovation are developing imaging techniques designed to predict whether a child's skull bones are likely to grow back together too quickly after surgery. They are also developing technologies that may delay a repeat of the premature fusion process.

"Babies are usually only a few months old during the first operation, which lasts more than three hours and requires a unit of blood and a stay in the intensive care unit, so our goal is to develop technologies that will simplify the initial surgery and limit affected babies to this one operation," said center co-director Joseph Williams, clinical director of craniofacial plastic surgery at Children's Healthcare of Atlanta at Scottish Rite and clinical assistant professor in the Department of Plastic and Reconstructive Surgery at Emory University.

Craniosynostosis affects approximately one in every 2,500 babies in the United States. The condition is caused by the premature closure of sutures with bone. Sutures, which are made of tissue that is more flexible than bone, play an important role in brain growth by providing a method for the skull to increase in size. If the sutures close too soon and get replaced with bony tissue, the skull may limit the normal expansion of the brain.

If untreated, craniosynostosis can cause a range of developmental problems. If treated using the standard treatment course, surgeons remove the fused skull bones, break them up, reposition them, and hold them in place with plates and screws. This usually slows bone growth between the bone pieces, allowing room for expansion of the brain. However, studies show that more than six percent of babies need a second operation to separate the bones again and 25 percent of those require a third operation.

What is craniosynostosis?

The normal skull consists of several plates of bone that are separated by sutures. The sutures (fibrous joints) are found between the bony plates in the head. As the infant grows and develops, the sutures close, forming a solid piece of bone, called the skull.

Craniosynostosis is a condition in which the sutures close too early, causing problems with normal brain and skull growth. Premature closure of the sutures may also cause the pressure inside of the head to increase and the skull or facial bones to change from a normal, symmetrical appearance.

"Following the first surgery, there's a clinical need to be able to screen children on a regular basis to predict when their skull bones are going to fuse together again so that the surgeons can determine if additional intervention will be required," said center director Barbara Boyan, the Price Gilbert, Jr. Chair in Tissue Engineering in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University and associate dean for research and innovation in the Georgia Tech College of Engineering.