Cranial Vault Surgery

Q: Dr. Eppley, I’m writing about my sons head. When he was born he had a flat forehead and  temples and his ears were aligned. At 4 months I noticed his forehead was slightly bulging forwards and I brought it up with my pediatrician who said the soft spot seems to have closed early. I asked should I get a helmet? He assured me a helmet won’t fix that and only surgery would. At the time I thought no, he isn’t getting surgery for a little bump. Over the next month I noticed his forehead started to bulge forwards much more and brought him to a cranial clinic for possibility of a helmet. They said it seems mild and it will go away as his forehead grows taller and flatten out. I was very happy to hear this. A month later I noticed the sides of his temples began to flair out and his forehead bulge forwards more. Frustrated I contacted the helmet clinic, they were shocked and said we can fit him in at ten months old but it’s probably too late. I am devastated by lack of care for my concerns initially. My sons head looks very very different from even eight weeks ago with the added bulging. The top of his head has expanded incredibly in width, there are large bumps and bony protrusions above his ears. His forehead is huge and his temples don’t sit back on the sides of his head any longer. They boss forwards into one large forehead and his ears stick right out now. I cry for him. I frequently get asked if he has a disability which hurts me. He is fine apart from his head, he is not disabled. He is 9 months old now and is just getting wider and worse. The bulges on the sides of his head are almost frightening. I know you are best in the world which is why I ask you for help.

I will attach photos of his head before and now.

I was wondering if you can change his life and do a cranial vault surgery to correct his skull to what it was before. He’s forehead and temples are now one. And there are large bumps on the sides of his head as well as a very protruding forehead. 

Please help him.

A: The growth of the brain is what drives the early shape of the skull. It goes to areas of least resistance. Whether cranial vault surgery is an option would depend on numerous factors:

1) What does a 3D CT scan show in terms of his various skull plates and the sutures between them?

2) Would a neurosurgeon consider operating on a non-synostotic infant? Cranial vault surgery is done in conjunction with a neurosurgeon so theri willingness to do so is the key factor in undergoing the surgery.

3) Would insurance ever approve a non-synostotic cranial vault surgery? This would require #1 and #2 above as well as a predetermination letter to answer that question. This is not a surgery that can be done on an out of pocket basis, the costs are simply too high.

Dr. Barry Eppley

Indianapolis, Indiana