CPT® Code 61550

1. Indications

The procedure is indicated for the treatment of craniosynostosis, specifically when a single cranial suture has fused prematurely. The following conditions warrant the performance of a craniectomy for craniosynostosis:

• Premature Closure of Cranial Suture The primary indication for this procedure is the early fusion of one cranial suture, which can lead to increased intracranial pressure and abnormal head shape.
• Abnormal Head Shape Infants presenting with noticeable deformities in head shape due to craniosynostosis may require surgical intervention to correct these abnormalities.
• Impaired Brain Development If the premature closure of the suture is affecting brain growth and development, surgical correction is necessary to prevent long-term neurological issues.
• Associated Syndromes In cases where craniosynostosis is part of a syndrome, such as Crouzon or Apert syndrome, surgical intervention may be indicated to address both cranial and associated abnormalities.

2. Procedure

The craniectomy for craniosynostosis involves several detailed procedural steps to ensure effective treatment. The following outlines the key steps involved in the procedure:

• Step 1: Skin Incision A skin incision is made over the affected cranial suture to provide access to the underlying skull. This incision is carefully planned to minimize scarring and facilitate healing.
• Step 2: Scalp Flap Elevation After the incision, a scalp flap is elevated to expose the skull. This step is crucial for accessing the cranial suture that requires intervention.
• Step 3: Drilling Burr Holes Burr holes are drilled along the planned craniectomy lines to facilitate the removal of bone. These holes serve as entry points for the surgical instruments used in the next steps.
• Step 4: Bone Wedge Removal A wedge of bone is excised from the skull. The specific location and shape of the bone wedge depend on the type of craniosynostosis being treated. For instance, in metopic craniosynostosis, the wedge extends from the soft spot at the crown of the head to the top of the nose, while in coronal synostosis, it extends from the soft spot to the ear on the affected side.
• Step 5: Additional Bone Cuts In cases of sagittal synostosis, additional bone cuts are made along the midline of the skull and at the back near the open suture area. These cuts are designed to allow for the removal of a rectangular section of the skull.
• Step 6: Shaping the Skull The bone is then cut diagonally at the top of the skull, extending to the soft spot, where a V-shaped section is removed. This step is essential for reshaping the skull and allowing for proper expansion.
• Step 7: Side Cuts and Wedge Removal Two side cuts are made on each side of the skull, and additional bone wedges are removed to facilitate the lateral expansion of the narrowed skull.
• Step 8: Closure of Incisions After the necessary bone removal, the incisions are closed in layers to promote healing and minimize complications.
• Step 9: Post-Operative Helmet Following the procedure, the infant is fitted with a custom-made helmet designed to assist in reshaping the skull as bone growth occurs.

3. Post-Procedure

Post-procedure care is essential for ensuring proper recovery and optimal outcomes. After the craniectomy, the infant will be monitored for any signs of complications, such as infection or excessive bleeding. The custom-made helmet will be worn to guide the reshaping of the skull as the child grows. Follow-up appointments will be necessary to assess the healing process and the effectiveness of the helmet in achieving the desired head shape. Parents or caregivers will receive specific instructions regarding care at home, including how to manage any discomfort and when to seek medical attention if concerns arise.