AURORA, Colo. — A pediatric surgeon at Children's Hospital Colorado is behind a new cranial surgery procedure that could speed up the recovery process for children with misshapen skulls.
Hannah Stallings is a ball of energy at 1.5 years old. She's got a strong personality, paired with a sweet side, and nothing can slow her down — not even cranial surgery.
"You would never know that that was part of her story," said Hannah's mom, Julie.
Hannah was only the second child to undergo this new cranial surgery to correct her craniosynostosis. Parts of Hannah's skull fused too early, causing her head to become misshapen. The condition can cause an abnormal head shape, developmental delays, and increased brain pressure.
"Oh, I mean I was sobbing," Julie said of when she first learned her daughter's diagnosis. "We knew that skull surgery was the only option. And so we were just scared, just very nervous and scared. There were a lot of unknowns, and I think that was the hardest part at first."
The family did their research before their first trip to Children's Hospital Colorado. They thought they knew what to expect when it came to Hannah's treatment plan.
"We went in thinking that we knew what we wanted, and Dr. Nguyen says, 'Well, I have a third option, and I'm doing the first one tomorrow,'" Julie recalled. "You know, the emotional side, you're terrified of letting your kid be the second one to have something done. But logically, it was just, made the most sense."
Dr. Phuong Nguyen is the chair of pediatric plastic and reconstructive surgery at Children's Hospital Colorado.
"Craniofacial surgery is still relatively new as a discipline. Historically, it has meant taking the skull apart and putting it back together. As you can imagine, that's a pretty big deal for a little baby," Nguyen explained. "We're seeing more and more now, children presenting so early, and that's actually a testament to pediatricians and other folks who are referring to us because they know something's not quite right. Because the kids are coming early, it offers us an opportunity to intervene earlier, but we have to devise a way to make it safe while still reaching the same goals and minimizing the amount of risk."
Nguyen said that for children under 6 months old, there is the ability to perform a minimally invasive surgery as opposed to an operation in which doctors take the skull apart. The traditional surgery, called an endoscopic strip craniectomy, requires a child to wear a helmet for roughly 12 months after the procedure to help mold their skull.
"That just means removing that part of the bone that's fused and then letting the brain do the rest," Nguyen said. "It works sometimes, and the reason I say sometimes is because with the unpredictability of what your head shape is going to be because you are just releasing the suture and allowing the brain to push out. It also requires a molding helmet to kind of help shape and steer where that skull is going to go, what it's going to look like. But that process can take up to 12 months or more, and that means wearing a helmet."
Nguyen decided to think out of the box, contemplating how surgeons could perform such a procedure more effectively. He decided to incorporate cranial springs into his concept.
"Cranial springs are also not new. They've been around for a good 25 years as well. Basically, the concept is, you have a titanium spring or a steel spring, and then you bend it into a shape that has a certain force. It just pushes things out," Nguyen said. "It's been pretty prominent in a lot of centers, mostly in Europe, but more adopted now in the US over the last decade or so. It's a tool like anything else. However, it really hasn't been used for this application. We thought about this long and hard, like, well, maybe this is an opportunity to try some of this technology that we've been using for other aspects."
The cranial springs must be watched closely once they are put into a child's skull because they work quickly, according to Nguyen. Once doctors have achieved their goal, the springs are removed in a small outpatient surgery.
"In some cases, that's all you need. You're done. No helmet," Nguyen said. "In some cases, where the child, in particular, is a little bit younger and the skull is still molding, then we put a helmet on just for fine-tuning. And so you go from 12 months [of wearing the helmet] down to just a few months."
Nguyen said the new procedure, which was just introduced around a year ago, requires a partnership with families who trust the process. He will explain the new procedure, followed by the more traditional option, which surgeons have quite a bit of experience performing. The third option is to wait until a child is older and undergoing the larger surgery on the skull. Nguyen said many parents are not interested in the third option.
Six months passed between Hannah's diagnosis and when she was able to remove her helmet — about half of the time a helmet would be necessary by the traditional option. Julie said Hannah only wore the helmet for roughly 2.5 months.
"Just to see how resilient she was, I think I had a harder time with it than she did," Julie said. "Somebody's got to be first at some point or there's not ever going to be anything new."
Approximately a year after Hannah's surgery, her doctors said she has met all of her milestones and is thriving.
Nguyen said they will closely watch the results of Hannah's surgery as she continues to grow. He said they want to monitor the changes in her skull over time, since there are seven years of growth before it becomes an adult-sized skull. Those long-term results are critical to determining if this procedure is superior to the other options for children with her condition.
