Giving a baby's brain the room to grow

Stollery’s first-in-Canada minimally invasive skull surgery marks 10th anniversary

EDMONTON — Ten-year-old Brandt Johner doesn’t remember the day he made medical history as a two-month-old In 2006 — when he became the first in Canada to get Endoscopic Unilateral Coronal Craniosynostosis surgery at Alberta Health Services’ Stollery Children’s Hospital.

Since then, the Grimshaw boy — whose newborn skull bones had fused together too early — has shown no ill effects or deficiencies. His surgery was performed with a then-new minimally invasive technique, as opposed to having a much-larger incision from ear-to-ear and the removal of parts of the skull and eye socket.

An infant’s skull is made up of several separate bones. Over time, these bones join together to form a mature skull. Craniosynostosis occurs when the bones fuse together early — often before the baby is born — instead of gradually joining together later in life. This causes abnormal skull growth, which gives the child’s head an unusual shape.

In Brandt’s case, the condition lifted one eye higher than the other, altered the shape of his nose and flattened his forehead. The usual treatment for this is surgical correction in the first year.

Using the minimally invasive method not only reduces complications as well as the need for blood transfusions, but the shorter operating time — an hour-and-a-half vs. four hours — also trims the time spent in hospital to 1-2 days from 3-4 days.

“The primary goals of surgery are to make room for the brain to grown properly, and to make cosmetic improvement to the skull,” says Dr. Vivek Mehta, divisional director of Pediatric Neurosurgery at the Stollery.”

Dr. Mehta went to Texas in 2006 to learn the surgical technique. While the procedure is not ideal for every child, he says the option made sense for Brandt who, being only two months at the time, would benefit most from the minimally invasive surgery to enjoy normal, healthy development.

Brandt’s operation involved incisions the size of a pencil eraser. Pieces of bone were removed through the small incisions with the aid of an endoscope. Afterwards, he needed to wear a custom helmet for several months to help shape his skull.

“The surgery however is only one component of the journey. The helmet construction and adjustments are critical in obtaining good results,” says Dr. Mehta. “This is truly a team process with input from nurses, occupational therapists, physical therapists, radiology, anesthesia, plastic surgeons and the orthotist.”

It’s currently estimated that in one in every 2,000 live births in Alberta, two of a newborn’s skull bones are going to close too early.

If left untreated, there’s a small chance that pressure may build up in the skull to cause irreversible brain damage. In some instances, the child’s brain compensates for the fused bones by growing in directions parallel to the closure. The resulting growth pattern may provide the space needed by a growing brain.

For example, in sagittal synostosis, the most common subtype of craniosynostosis, an untreated child’s skull can take on the shape of a football, a significant cosmetic deformity.

The Pediatric Head Shape Clinic at the Stollery sees about 40-50 children per week and refers those with potential synostosis for a neurosurgical consult. About two to four per cent of these young patients are diagnosed with Craniosynostosis.

Since Dr. Mehta’s pioneering surgery in 2006, the procedure has been used more than 50 times at the Stollery, and has also been performed in Calgary, Vancouver and Toronto.

Brandt’s parents, Amber and Harley Johner, still recall their baby’s two-week checkup in Peace River — they were told they needed see a specialist in Grande Prairie the following day. There, after a CT scan and an X-ray, Brandt was diagnosed with Craniosynostosis. Only three weeks later, the Johners found themselves at the Stollery.

“It was so confusing at the beginning,” says mother Amber. “It was scary listening to Dr. Mehta explain different neurosurgery options for our baby boy. Even though it had never been done before, we decided on the less-invasive procedure with Dr. Mehta, because it seemed the least scary. We couldn’t be happier with how things turned out.”

For his part, Brandt finds it pretty cool to be part of a Canadian medical milestone, and enjoys being able to do everything expected of kids his age.

“We were told he could have vision problems, headaches, or even developmental delays,” says Amber, “but we haven’t seen any sign of that. Brandt is the smartest in his class, plays hockey, swims and snowboards.”

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

- 30 -