A New Technique for Unicoronal Craniosynostosis Takes Shape

An infant’s skull contains flexible sutures that allow the brain to grow. In children with unicoronal craniosynostosis, one of the coronal sutures in the skull fuses prematurely, causing a misshapen head and posing neurodevelopmental risks. Traditional treatments for unicoronal craniosynostosis typically involve fronto-orbital advancement, an invasive skull surgery that carries significant morbidity. An endoscopic strip craniectomy may also be used to treat the condition in younger children, though it carries less predictable results and requires patients to wear a helmet postoperatively.

Children’s Hospital Colorado Chair of Pediatric Plastic and Reconstructive Surgery, Phuong Nguyen, MD, is helping revolutionize treatment for unicoronal craniosynostosis through distraction osteogenesis, a technique that works to slowly stretch the bone over time. Instead of removing parts of the skull and installing plates and screws — the steps involved in a fronto-orbital advancement — this technique helps the skull gently repair itself. It borrows methods from limb growth procedures, which surgeons might use to help even out a person’s legs when they are different lengths.

“It’s the same idea: Cut the bone, slowly stretch it and then bone will grow in between,” Dr. Nguyen says. “Because we’re moving things in a gradual fashion, it gives time for the bone to remodel and reshape.”

Distraction of the craniofacial skeleton was initiated for unicoronal craniosynostosis in South Korea 10 years ago, and in the United States, it has only been used in a handful of centers. Dr. Nguyen refined the Korean technique into its current form by incorporating remodeling of the temporal bone, which improves its shape and better protects the brain, making this a safer operation. He completed one of the first successful distraction osteogenesis operations in Texas, then published a step-by-step report of his technique in 2021.

Dr. Nguyen is bringing his far-ranging expertise to the Rocky Mountain region, helping families near and far facing unicoronal craniosynostosis benefit from a less invasive surgery with more reliable results.

1. Nguyen, Phuong D et al. “Distraction osteogenesis with temporal bone remodeling for unicoronal craniosynostosis.” Neurosurgical focus: Video vol. 4,2 V15. 1 Apr. 2021, doi:10.3171/2021.1.FOCVID20121.