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Our approach

The skilled team of pediatric neurosurgeons and pediatric craniofacial surgeons at Cohen Children’s provides the highest quality care in craniofacial abnormalities and handles the largest volume of cases on Long Island. The craniofacial plastic surgeons often involved are also dedicated to the treatment of children. 

We also have the capability to do three-dimensional modeling before treatment, allowing us to plan a reconstruction for some cases.

Endoscopic, minimally invasive techniques are used quite early and have a high success rate of avoiding larger craniofacial reconstructions.

Overview 

In the context of neurosurgery, craniofacial abnormalities are abnormalities of the growth of the skull, which may constrict brain growth. (There are other types of craniofacial abnormalities, such as cleft lip, that do not involve neurosurgery.)

A common type of craniofacial abnormality is craniosynostosis. This is when children are born with premature fusion of one or more of the growth plates (or sutures) of the skull. Their brains grow but their skulls cannot, resulting in abnormal head shapes. 

Some genetic syndromes (such as Crouzon syndrome and Apert syndrome) are complex and involve other aspects of the body—requiring a comprehensive, multidisciplinary approach to treatment.

Causes & risk factors

The cause of most craniofacial abnormalities is unknown, but sometimes genetics play a role.

Symptoms 

Marked by abnormal head shape and/or size, craniofacial abnormalities are usually recognized by a pediatrician after birth. A head shape abnormality can sometimes be detected in a late-term ultrasound, but this is less common.

Diagnosis & testing

We evaluate your child’s head shape to help determine a diagnosis. Sometimes MR imaging is used to look for brain abnormalities. Sometimes CT is used to plan surgical procedures in complex cases.  Whenever possible we attempt to limit radiation exposure to the growing brain and most patients do not require CT.

Treatment options 

Craniosynostosis repair is often done at a very young age, sometimes less than 3-4 months old, while other times closer to 1 year old. Cohen’s has one of the busiest programs for craniosynostosis repair in the region. We use two main techniques; one is the open reconstruction of the skull, and the other is a minimally invasive endoscopic approach which may be followed by helmet therapy.

Other techniques include distraction osteogenesis. In these cases, we make cuts in the skull and attach a device that gradually expands the skull to make more room over many weeks.

Fixation of cranial plates are generally accomplished using absorbable material which disappears within two years.

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